Hello everyone! I would like to go more into the different therapies of Psoriasis because we discussed as a group that there could be a lot of options.
UVB for psoriasis
UV therapy is one of the first line therapies available for chronic plaque psoriasis, if available. The type of light that is used to treat psoriasis is UVB phototherapy. There are different types of UVB therapy, narrow-band, broad-band, and laser UVB. Narrow-band phototherapy is the most common light therapy and limits wavelengths used. Broad-band UVB therapy is the oldest form of light therapy and has a wider wavelength. Excimer Laser UVB lastly is for targeting smaller areas. Healthcare professionals use this type of therapy when the psoriasis is affecting less than 5 percent of the body. Some benefits to narrow-band UVB is that the light release a smaller range, making it able to clear psoriasis faster and give longer remissions. This treatment might also be quicker than the other types of UVB treatments. It is estimated that about 75% of people using UVB therapy will develop clear skin.
https://www.psoriasis.org/about-psoriasis/treatments/phototherapy#uvb
https://www.medicalnewstoday.com/articles/323593#types-of-light-therapy
Biologic therapies have significantly advanced the treatment regimens for chronic inflammatory skin disorders like plaque psoriasis and atopic dermatitis. These biologics are typically used for patients who are unresponsive to conventional systemic therapies. They are usually monoclonal antibodies or receptor antagonists, that target particular immune mediators involved in skin inflammation, providing a favorable safety profile and efficacious responses.
In psoriasis, biologics typically target components of the interleukin 23/17a pathway or the tumor necrosis factor alpha (TNFa) pathway. Some biologics that have shown efficacy in skin clearance and symptom improvement are Ustekinumab (IL 12/23 inhibitor), Guselkumab (IL23 inhibitor), Secukinumab and Ixekizumab (IL17A inhibitor), and adalimumab or etanercept (TNFa inhibitor). In atopic dermatitis, dupilumab is an FDA approved biologic that targets the IL4 receptor alpha subunit.
Biologic therapies are typically well tolerated. However, some adverse effects can include injection site reactions, upper respiratory tract infections, headaches, and potentially conjunctivitis. TNFa inhibitors are associated with a risk of tuberculosis reactivation, making pre-treatment TB screening essential. IL-17 inhibitors have been linked to new or worsening inflammatory bowel disease (IBD) in rare cases. As pharmacists, we are responsible for ensuring appropriate baseline screening (TB testing/hepatitis panels), reviewing vaccination history, and monitoring for adverse effects throughout therapy.
Biologics require specialized knowledge of dosing regimens, storage requirements, insurance authorization, and patient education. Most agents are administered subcutaneously and may be self-injected at home. Therefore, it is important to counsel on teaching proper injection technique, managing injection-site issues, and reinforcing adherence to the dosing schedule. In addition, pharmacists are key in navigating access issues, including prior authorizations and manufacturer patient assistance programs.
Biologics have transformed the management of chronic dermatologic diseases, offering targeted treatment with high efficacy and manageable side effect profiles. Pharmacists in both ambulatory care and specialty pharmacy settings are positioned to play a critical role in optimizing biologic therapy through clinical monitoring, patient education, and healthcare coordination.
Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA. 2020;323(19):1945–1960. doi:10.1001/jama.2020.4006
Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an IL-23–specific monoclonal antibody, compared with adalimumab for the treatment of moderate-to-severe psoriasis: a randomized, double-blind, placebo- and active comparator–controlled phase 3 trial (VOYAGE 1). Lancet. 2017;389(10066):1085–1094. doi:10.1016/S0140-6736(17)30238-2
Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016;375(24):2335–2348. doi:10.1056/NEJMoa1610020