Tailored biological treatment for patients with moderate-to-severe psoriasis

Introduction Psoriasis is a common, chronic immune-mediated skin disease frequently associated to inflammatory and metabolic comorbidities. About 20-30% of patients are affected by moderate-to-severe psoriasis and require a systemic treatment, which include traditional and biological drugs. The objective of this manuscript is to provide criteria for a personalized biological treatment. Areas covered Tailoring a biological treatment for patients with moderate-to-severe psoriasis needs to consider several variables related to the disease, the patient and the treatment. It is important to consider the disease severity and activity, the skin areas involved, the frequency of relapses, itch or other symptoms, and foremost the presence of comorbidities. About the patient, is important to consider age, gender, body weight, the occupation, the impact on the quality of life, the likelihood of adherence, patient expectations, the desire for remission, and the fear of side effects. Expert opinion The presence of comorbidities, which may benefit from or contraindicate a given biologic, is the main driver of a tailored therapy. A personalized treatment associates maximum efficacy and minimal risk of side effects. In addition, there is the possibility of modifying disease-course inducing long-term remission and preventing the development of psoriatic arthritis. Plain Language Summary Psoriasis is a chronic inflammatory disease affecting 2-3% of the population worldwide. It is characterized by erythematous and scaling plaques generally localized on the extensor surfaces, such as elbow and knees. In almost one-third of cases, it is diffuse and affecting wide areas of the body surface including the nails and it is significantly interfering with the patients' well-being. Psoriasis is frequently associated to comorbidities including inflammatory and metabolic disorders such as psoriatic arthritis, obesity and diabetes. Pharmacotherapies including monoclonal antibodies specifically targeting different pathogenetic mediators are available for the treatment of moderate-to-severe psoriasis. Several factors including the age, gender, localization of psoriasis, and comorbidities could influence the treatment selection of targeted pharmacotherapies. A personalized treatment associates maximum efficacy and minimal risk of adverse effects.