Biologics as New Treatment Options in the Treatment of Psoriasis and Psoriasis-Arthritis

About 1.6 million individuals suffer from psoriasis in Germany. Many of them can be treated with topical ointments, but about 20% exhibit such a severe disease, that topical treatment is not sufficient. The classical systemic treatments (methotrexate, cyclosporine, fumarates, retinoids) and UV-therapies are successful in only a fraction of patients, may cause adverse effects (e.g. liver or kidney toxicity and teratogenicity) especially during long-term treatment, or are contraindicated due to concomitant diseases. The increasing elucidation of the pathogenesis of psoriasis and the progress made in biotechnological techniques has led to the development of new therapeutic strategies. In the last two years, four so called "biologics" have been approved in Germany for the treatment of psoriasis and/or psoriasis arthritis: Enbrel (R) (Etanercept), Humira (R) (Adalimumab), Raptiva (R) (Efalizu-mab) and Remicade (R) (Infliximab). These provide new effective and, at least for short-term treatment, safe therapeutic alternatives. Up to now, we are allowed to use them only as second-line therapeutics. Before prescribing biologics we should carefully reflect on the correct indication and keep the costs in mind, which are much higher than for standard systemic or UV-therapies. Moreover, there are still some questions that need to be addressed in the next few years: Why are biologics only effective in a number of patients? Will there be a possibility to differentiate between responders and non-responders before the start of treatment? How safe are the biologics in long-term use?