Biologic Therapy in Psoriasis (Part I): Efficacy and Safety of Tumor Necrosis Factor- α Inhibitors

Background: Psoriasis is a chronic immune-mediated inflammatory disorder, with an estimated global prevalence of 2-3%. Psoriasis is associated with an impaired health-related quality of life and a substantial economic burden. Biologics, which target the pathways involved in the pathogenesis of psoriasis, represent an established therapeutic approach for moderate-to-severe plaque psoriasis, with remarkable efficacy and safety profile extensively examined and monitored. Methods: Biological therapies currently available can be divided into three main categories: the TNF alpha antagonists (infliximab, adalimumab, etanercept, golimumab, certolizumab pegol), the interleukin (IL)-12/23 monoclonal antibody (ustekinumab), and IL-17 inhibitor (secukinumab, ixekizumab). Results: In this section, we explore the complex role of TNF alpha in psoriasis as well as the efficacy and safety of TNF alpha inhibitors largely used in the management of the cutaneous disease. Conclusion: Dosing regimens, administration, pharmacodynamics profiles, efficacy, and safety of licensed anti-TNF alpha are here discussed in detail.