Since the introduction of Alefacept, the first biologic agent approved by the US FDA for psoriasis treatment in 2003, the field of psoriasis biologic therapy has developed rapidly and become an important research progress in recent years. The biologic agents that have been approved for psoriasis clinical treatment mainly include monoclonal antibody (monoclonal antibody) agents and recombinant fusion protein agents, and the target molecules mainly include tumor necrosis factor alpha (TNFα), interleukin 12/23, T-cell activation-related molecules, etc. Examples are as follows: Inflaximab: anti-TNFα human-mouse chimeric antibody, which is the first monoclonal antibody agent approved for psoriasis treatment. The first monoclonal antibody approved for psoriasis treatment, mainly for arthritic psoriasis and moderate to severe plaque psoriasis, but also effective for erythrodermic psoriasis and pustular psoriasis. Dosage: 5 mg/kg once at weeks 0, 2 and 6, VD, maintenance treatment every 8 weeks. The expected onset of action is 1-2 weeks, and the efficacy reported in the literature (PASI 75) is 60-80%, with opportunistic infections such as tuberculosis as the main adverse effect. The U.S. FDA pregnancy safety classification is B. Adalimumab: Anti-TNFα fully human monoclonal antibody with the same indications as infliximab, but adalimumab may still be effective when infliximab or other TNFα inhibitors are not effective. It is administered as an initial 80 mg, followed by 40 mg every 2 weeks by subcutaneous injection. The expected onset of action is 4 weeks, with discontinuation if the application is ineffective for 12 weeks. The efficacy reported in the literature (PASI 75) ranges from 53% to 80%. There is also a risk of opportunistic infections such as tuberculosis, but this preparation is a fully human antibody, so the incidence of side effects such as allergic reactions is low. The US FDA pregnancy safety classification is B. Anti-IL-12/IL-23 monoclonal antibody (Ustekinumab): It is a fully human monoclonal antibody formulation against IL-12/IL-23 (P40 subunit), approved for marketing in 2009, mainly used in arthritic psoriasis and moderate-to-severe plaque psoriasis. Dosage: 45-90 mg, subcutaneously at weeks 0 and 4, and every 12 weeks thereafter. The expected onset of action is 1-2 weeks. Current clinical observations suggest superiority over anti-TNFα monoclonal antibodies in terms of onset of action, efficacy and safety. The main side effects are opportunistic infections and cardiovascular problems. Efalizumab: humanized anti-CD11a (alpha subunit of LFA-1) monoclonal antibody for moderate-to-severe plaque psoriasis, ineffective in arthritic psoriasis, and of uncertain efficacy in other types of severe psoriasis. It is less effective than the above monoclonal agents in plaque psoriasis and has been warned by the FDA in the United States for several cases of severe infection – multifocal leukoencephalopathy (PML). The FDA pregnancy safety rating is C. Etanercept: recombinant fusion protein of the Fc segment of the TNFα receptor and human IgG1, with the same indications and precautions as the TNFα monoclonal agent, with an efficiency (PASI 75) of about 50% and a low incidence of adverse reactions. Alefacept: recombinant fusion protein of LFA-3 and the Fc segment of human IgG1, the first biologic agent approved by the FDA for psoriasis (2003), for arthritic psoriasis and moderate-to-severe plaque psoriasis. Dosage: 15 mg once weekly by intramuscular injection for 12 weeks, this course may be repeated if needed but at least 12 weeks apart. The expected onset of action is 2-6 weeks. Due to the slow onset of action, the onset of action can be shortened by combining with UVB at the beginning of treatment. The efficacy rate (PASI 75) is 21-33%, with side effects such as headache, WBC reduction, and infection. Although there is a lack of large-scale clinical studies and evidence-based medical evidence for the use of biologics in the treatment of severe psoriasis, there have been many clinical observations showing that various monoclonal antibodies or fusion protein drugs have the advantage of fast onset and high efficacy and can be used in patients with severe disease. They are expected to improve in a relatively short period of time. Biologics remain an ideal option to save patients in complex cases with resistance or significant adverse reactions to other treatments, as well as in severe psoriasis during pregnancy. It should be noted that so far (October 2011) no biologic agent has been approved in China for the treatment of psoriasis vulgaris. I have the following basic views on the biological treatment of psoriasis: 1. Biological treatment represents new progress and the development direction at this stage, and can be used as a new type of therapy or for difficult and critical psoriasis cases; 2. 3.The potential infection rate of chronic infectious diseases such as tuberculosis in China is high, and the risk of serious infections such as disseminated tuberculosis after applying biological agents is greater than that in developed countries; 4.The cost is expensive, and not all patients can afford it yet. For most patients with average economic conditions, it is still appropriate to choose traditional methods and to carry out regular treatment under the guidance of the principle of “typing, grading and standardized treatment”.