Biological therapies for the treatment of psoriasis in pediatrics

ABSTRACT

Introduction

Psoriasis is a multifactorial, immune-mediated condition with predominant skin involvement. It may develop at any age. In one-third of patients, the first symptoms of psoriasis start during childhood or adolescence. A marked impairment of the quality of life of patients and their caregivers is often associated.

Areas covered

Databases including PubMed and Clinicaltrials.gov were used to identify clinical studies involving pediatric patients with psoriasis. In the last few years, the implementation of therapy with drugs targeting cytokines like interleukin (IL)-12/23 and IL-17A has expanded the number of available therapeutic options in pediatric psoriasis. This review focuses on the latest evidence on the clinical efficacy and safety profile of drugs licensed for severe pediatric psoriasis.

Expert opinion

Increasing knowledge about the pathogenetic mechanisms underlying pediatric psoriasis is leading to an improvement in disease management. Effective treatment is crucial in patients affected with moderate to severe disease to reduce the burden of the disease and avoid stigmatization. The treatment of pediatric psoriasis remains challenging for specific clinical subtypes, when difficult areas are involved, after resistance to multiple treatments, and when psoriatic arthritis is associated. A personalized approach and a thorough understanding of the disease are required to advance pediatric psoriasis care.

KEYWORDS:

• Psoriasis
• therapy
• treatment
• pediatrics
• childhood
• biologic

Article highlights

• Recently, more studies have focused on the use of biologics in pediatric psoriasis, and new biologics have been approved for use therein.

• Currently, approved treatment options offer a differentiated range of options for pediatric psoriasis, such as tumor necrosis factor (TNF) inhibitors; inhibitors of IL-17A (IL-17A), and IL-12/23 (IL-12/23).

• IL12/23 and IL-17A inhibitors have shown clear superiority with respect to TNF-alpha blockers concerning efficacy on skin clearing according to randomized clinical trials. However, there is limited evidence about real-world data.

• Pediatric psoriasis may be undertreated if localized in limited, but difficult-to-treat areas. Clinicians must balance relative risks and potential benefits when developing a treatment strategy in these particular clinical scenarios.

• Research underlines the promise of pharmacogenomics for personalized psoriasis care as well as the necessity to improve therapy efficacy in specific psoriasis variants and localizations.

Declaration of interest

V Di Lernia has received consultancy/speaker’s honoraria from and/or participated in clinical trials sponsored by Abbvie, Almirall, Amgen, Lilly and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have worked on clinical trials for all drugs mentioned in this paper and that they are an advisor to Amgen, Eli Lilly, BMS and Abbvie. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.