Comparing biological therapies in psoriasis: implications for clinical practice

Treatment of severe or recalcitrant plaque psoriasis with traditional systemic therapies may be limited by efficacy or safety/tolerability considerations. The latest information on the pathophysiology of psoriasis and its targeted treatment with biological therapy points to an emerging new treatment paradigm: continuous and earlier systemic therapy. However, few comparative trials of systemic treatments for psoriasis have been conducted. The Active Comparator (CNTO 1275/Enbrel) Psoriasis Trial (ACCEPT) is the first head-to-head superiority study comparing two biological agents (ustekinumab and etanercept) in the treatment of plaque psoriasis. The results show that ustekinumab, given as two injections over a 12-week period, achieves significantly superior clinical improvement compared with etanercept 50 mg twice weekly. The level of response was consistent with previously published data for both drugs, and may have important implications for the management of psoriasis.