Our understanding of psoriasis has gone a long way from its initial status as a simple skin disease to the discovery that it can be co-morbid with cardiovascular disease, urinary disease, and immune disorders.
Fortunately, as our knowledge of psoriasis has deepened, its treatment methods have become increasingly abundant. In particular, in the past 20 years, the rapid development of research on psoriasis genetics and immunological mechanisms has led to the emergence of new targeted therapeutic drugs for psoriasis, which has opened a new era of psoriasis treatment and brought a new dawn to psoriasis patients.
A. Recognize innovative drugs and apply them correctly to help psoriasis patients “regain their lives”
1.Tumor necrosis factor alpha (TNF-α) inhibitors
TNF-α is a commonly chosen target in the treatment of psoriasis, a potent pro-inflammatory factor that functions in a variety of cells and is highly expressed in chronic inflammatory diseases such as psoriasis. Currently, TNF-α inhibitors include etanercept, infliximab, adalimumab, certolizumab, and golimumab. In particular, adalimumab, with its high improvement rate, long maintenance of efficacy and low immunogenicity, is widely used in clinical practice for moderate and severe psoriasis that is refractory to other treatment regimens.
2.Interleukin (IL) receptor inhibitors
Among them, IL-17A and its receptor antagonists are sulginomab, exekisumab and brodalumab. The first two of them are suitable for adult patients with moderate or severe plaque psoriasis. The latter is indicated for patients who are amenable to systemic therapy or phototherapy and for whom other systemic therapies have failed or are ineffective. There are also IL-12/IL-23 antagonists, including utekinumab, guselkumab, and brenuzumab, all of which are indicated for the treatment of patients with moderate to severe plaque psoriasis. Common adverse effects during dosing are nasopharyngitis, upper respiratory tract infections and headache and malaise. Compared with TNF-α inhibitors, IL-23 inhibitors are more effective and have shown good efficacy and safety in the treatment of psoriasis, with high clinical response rates and significant improvement in the quality of life of psoriasis patients.
3. phosphodiesterase 4 (PDE-4) inhibitors
As of July 2018, the oral PDE-4 inhibitors that have been marketed worldwide include Apoest, which can treat and control psoriasis symptoms by inhibiting PDE-4 activity, blocking cAMP hydrolysis, increasing intracellular cAMP levels, and reducing the expression of multiple pro-inflammatory factors while promoting the expression of anti-inflammatory factors, thereby regulating the inflammatory response. In addition, there are several PDE-4 inhibitors in the development stage.
4, T-cell targeted therapeutics
As of July 2018, the T-cell targeted therapeutics that have been marketed globally include afaxipro, irinizumab, and efalizumab. Among them, efalizumab was withdrawn from the market in 2009 because it can increase the risk of progressive multifocal leukoencephalopathy and can induce serious infections.
5.Small molecule inhibitors of cell signaling
Small molecule inhibitors of cell signaling currently studied for the treatment of psoriasis include blocking Janus kinase (JAK) inhibitors, protein kinase C (PKC) inhibitors, etc. As of July 2018, foreign JAK inhibitors that have been marketed include tofacitib, olaratinib and ruxolitinib, and domestic JAK inhibitors that have been marketed include tofacitib; JAK inhibitors that have entered clinical trials include baricitinib and other drugs, the specific efficacy and safety of which have yet to be verified.
Second, a new era of psoriasis treatment is still being opened
So far, psoriasis still cannot be cured and requires long-term medication. In addition to the above-mentioned targeted drugs already in clinical application or in clinical trials, with the in-depth research on the pathogenesis of psoriasis and the development of related disciplines such as material science, more therapeutic targets need to be researched and translated into clinical application, such as nerve growth factor inhibitors, chemokine receptor antagonists, mitogen-activated protein kinase inhibitors, STAT inhibitors, etc., which may play a therapeutic role in psoriasis in the future. They may play a therapeutic role in psoriasis in the future, so that the treatment plan of psoriasis can be optimized continuously to achieve a more accurate and safer treatment effect for the benefit of more psoriasis patients.
There is no night that will not pass, and the “battle” of psoriasis will definitely be won in the future. All we have to do now is to treat well and wait well, and watch the night slowly recede and the sun shine on the earth on behalf of hope.
References
[1]Shu X, Tu XJ, Chen Yang, et al. Research progress on the pathogenesis and targeted therapy of psoriasis[J]. Medical Review,2022,28(01):23-27.
[2]Wei Yiying,Li Shimeng,Wei Wenguo,et al. Research progress of psoriasis treatment drugs[J]. Chinese Contemporary Medicine,2021,28(02):30-36.
[3]Ren Yunqing,Wang Wenjun,Zhang Xuejun. New targeted therapeutic agents develop rapidly to open a new era of psoriasis treatment[J]. Chinese Medical Information Herald,2021,36(22):16-17.