Biologic Therapies: Clinical Practice in a Changing Environment

Biological therapies have been in use for treating psoriasis for a decade now, and they have greatly improved disease outcomes and quality of life for patients. The success of biologic therapies has been assisted by the development of evidence-based guidelines for their use, and the achievement of consensus on treatment goals. The future of biologic therapies for psoriasis will be different from the past decade, with new anti-inflammatory targets for antibodies being developed and the increasing availability of biosimilar versions of existing antibodies as patents expire. While reduced costs may exert a pressure to switch to biosimilars, it is important to appreciate that they may not be identical in efficacy. Biologics are large, complex molecules, produced by biosynthetic means, which inherently lead to variations in structure. These slight variations in the manufacture of biologics can lead to clinically relevant changes in efficacy. As more biosimilars become available, their interchangeability becomes an important challenge for use in clinical practice, both between a biosimilar and the originator, and between two different biosimilars. Thus, robust trials of interchangeability are urgently needed. Caution in the use of an increased range of biosimilars will also be needed as switching between drugs can potentially increase immunogenicity and neutralise the drug’s efficacy.

The introduction of biologic therapies has been a great achievement in the treatment of psoriasis. The new biologics and biosimilars coming into practice will need to be used with care, for which robust data on safety, efficacy, and interchangeability will be needed, as well as continuing pharmacovigilance.