Advances in immunotherapy for moderate-to-severe psoriasis: a narrative review
DOI:
https://doi.org/10.55892/jrg.v9i20.2985Keywords:
Psoriasis, Immunotherapy, Biologic Therapy, Interleukin-17, Interleukin-23, Moderate-to-Severe DiseaseAbstract
This study aimed to critically analyze advances in immunotherapy for moderate-to-severe psoriasis over the past decade, with emphasis on clinical efficacy, safety profile, and the consolidation of the IL-23/Th17 axis as a central therapeutic target. This narrative review was conducted using a qualitative and analytical-descriptive approach. A literature search was performed in PubMed/MEDLINE, SciELO, and ScienceDirect, covering publications from January 2016 to February 2025. Randomized controlled trials, phase III multicenter studies, systematic reviews, meta-analyses, clinical guidelines, and observational studies indexed and identified by DOI were included. Pivotal trials published prior to the defined period were incorporated when considered essential for historical contextualization and understanding of therapeutic evolution. The evidence consistently demonstrates the superiority of IL-17 and IL-23 inhibitors compared with TNF inhibitors and IL-12/23 blockers, particularly in achieving stringent clinical outcomes such as PASI 90 and PASI 100. Phase III trials and head-to-head comparative studies confirm greater magnitude and durability of clinical response, alongside a favorable cardiovascular and infectious safety profile. Although these findings establish IL-17 and IL-23 inhibitors as leading therapeutic options in contemporary management, methodological heterogeneity and interindividual variability in treatment response highlight the need for precision medicine strategies to optimize therapeutic decision-making in moderate-to-severe psoriasis.
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References
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