Psoriasis: a personalized approach to therapy. The preferred choice of systemic agents considering comorbid pathologies

Psoriasis is a chronic inflammatory skin disease that is currently viewed as a systemic process due to its association with many comorbid conditions. With the appearance of genetically engineered biological drugs (GEBDs), the treatment of psoriasis has undergone significant changes due to their high efficiency and favorable safety profile. It has been clinically proven that the use of this type of therapy has a positive effect, including on comorbid diseases. However, it must be highlighted that some types of drugs can have a negative effect on the course of these conditions. The characteristics of each individual drug, such as the rate of onset of remission, long-term efficacy, safety profile and effect on comorbidities are different. A better understanding of these characteristics leads to the correct personalized choice of therapy, hence to improved survival of drugs, patient satisfaction and minimization of the impact of psoriasis on the quality of life of patients.
This article examines the efficacy and safety of biological drugs in patients with psoriasis, discusses their effect on concomitant diseases pathogenetically associated with psoriasis.
To date it is known that the signaling pathway IL-23 / IL-17 plays a key role in the pathogenesis of psoriasis. Promising results are shown by the use of a biological drug aimed at inhibiting IL-23, namely the IL-23 blocker guselkumab. In addition to the high level of therapeutic response in psoriasis, other properties oa the drug have been identified - it has also shown efficacy in patients with concomitant Crohn's disease. Studies describe positive responses in the guselkumab treatment of psoriasis with “difficult” localisations, psoriatic arthritis and Hidradenitis Suppurativa, and its use in patients with cardiovascular risks did not lead to any manifestations of negative dynamics. Thus, further study of the effect of the IL-23 blocker on comorbid pathologies in psoriasis is a promising area.

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