An update on drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis

Objective: Moderate-to-severe psoriasis is a chronic skin condition that often requires systemic therapy and biologics are the newest systemic treatment available. A favorable aspect of biologics is that they are thought to have minimal risks for drug-drug interactions compared to oral systemic medications such as cyclosporine and methotrexate. However, this assumption has not been recently or adequately reviewed. We reviewed the literature to identify possible drug-drug interactions with biologics and other medications. Methods: We searched PubMed for published case reports, clinical studies, reviews, and Food and Drug Administration (FDA) labels discussing possible drug-drug interactions with biologics for the treatment of moderate-to-severe psoriasis. Results: There were only a small number of published articles describing drug-drug interactions with biologics. Our review identified two case reports, five clinical studies, and three pharmacokinetics reviews. The majority of articles did not observe clinically relevant drug-drug interactions with biologics. FDA labels do suggest a possible relationship between tumor necrosis factor (TNF)-alpha inhibitors and cytochrome P450 (CYP) activity. Conclusion: The paucity of information regarding drug-drug interactions reaffirms the idea that biologics have limited susceptibility to drug-drug interactions compared to other oral medications. Further studies are needed to adequately assess drug-drug interactions with biologics.