Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia Street 72, Nola (NA), Italy.
IRCCS Humanitas Research Hospital, Manzoni Street 56, 20089 Rozzano, Milan, Italy.
Int Immunopharmacol. 2024 Dec 25;143(Pt 1):113388. doi: 10.1016/j.intimp.2024.113388. Epub 2024 Oct 14.
Psoriasis is a chronic inflammatory skin disease affecting millions of people worldwide, characterized by rapid proliferation of keratinocytes, immune cell infiltration, and systemic inflammation. Over time, treatment strategies have evolved significantly from traditional topical therapies and phototherapy to advanced systemic options such as biologics and, more recently, oral small molecule drugs. This review aims to provide an in-depth examination of current psoriasis therapies, with a focus on biologics, oral small molecules, and new and emerging treatments. Several classes of biologic therapies have received regulatory approval for psoriasis, including inhibitors of TNF-α, IL-12/23, IL-17, and IL-23. Biologics have transformed psoriasis care, offering improved disease management and quality of life for patients, with generally favorable safety profiles. However, challenges such as high cost, potential immunogenicity and complexity of administration have sparked interest in alternative treatment options. Oral small molecules, particularly Janus kinase (JAK) inhibitors, have gained attention for their efficacy and ease of use, being orally administered drugs. These drugs mark a shift in therapeutic paradigms by providing an oral option that precisely targets specific signaling pathways. In addition to existing therapies, this review also highlights emerging treatments that could shape the future of psoriasis care, including new small-molecule inhibitors. Early clinical trials suggest that these agents could improve treatment outcomes for psoriasis patients. Current research is increasingly focused on understanding disease recurrence, particularly the influence of tissue-resident memory T cells (TRMs). Avoiding the proliferation of these cells may be crucial in attenuating recurrence. In particular, interleukin-23 (IL-23), produced by CD301b+ cells, has been linked to stimulation of TRM cell proliferation in the skin. This finding highlights that IL-23 inhibitors and treatments targeting CD301b+ cells are promising strategies for maintaining remission and preventing relapse. In summary, the landscape of psoriasis treatments is advancing rapidly, with an increasing focus on personalized, patient-specific therapies. Research is expected to continue to refine and improve therapeutic approaches for this complex disease.
银屑病是一种影响全球数百万人的慢性炎症性皮肤病，其特征是角质形成细胞的快速增殖、免疫细胞浸润和全身炎症。随着时间的推移，治疗策略已经从传统的局部治疗和光疗显著发展为先进的全身治疗选择，如生物制剂，以及最近的口服小分子药物。本综述旨在深入探讨当前的银屑病治疗方法，重点介绍生物制剂、口服小分子药物以及新出现的治疗方法。几种类别的生物制剂已获得监管部门批准用于银屑病治疗，包括 TNF-α、IL-12/23、IL-17 和 IL-23 的抑制剂。生物制剂已经改变了银屑病的治疗方式，为患者提供了更好的疾病管理和生活质量，且通常具有良好的安全性。然而，高成本、潜在的免疫原性和给药的复杂性等挑战引发了对替代治疗选择的兴趣。口服小分子药物，特别是 Janus 激酶（JAK）抑制剂，因其疗效和易用性而受到关注，它们是口服药物。这些药物通过提供针对特定信号通路的口服选择，标志着治疗模式的转变。除了现有的治疗方法外，本综述还强调了可能塑造银屑病治疗未来的新兴治疗方法，包括新的小分子抑制剂。早期临床试验表明，这些药物可以改善银屑病患者的治疗效果。目前的研究越来越关注了解疾病的复发，特别是组织驻留记忆 T 细胞（TRM）的影响。抑制这些细胞的增殖可能是减轻复发的关键。特别是，由 CD301b+细胞产生的白细胞介素-23（IL-23）已被证明与皮肤中 TRM 细胞增殖的刺激有关。这一发现表明，IL-23 抑制剂和针对 CD301b+细胞的治疗方法是维持缓解和预防复发的有前途的策略。总之，银屑病治疗领域正在迅速发展，越来越注重个性化、针对患者的治疗方法。预计研究将继续完善和改进治疗这种复杂疾病的方法。
