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Psoriasis: future drugs

Abstract Over the last 20 years, understanding of the pathogenic mechanisms underlying psoriasis has advanced significantly. Psoriasis is accepted as a T cell-mediated disease in which chemokines and cytokines have an essential role. Recombinant DNA technology has enabled scientists to manufacture in bulk proteins that can modulate the immune response. These proteins, known as biological agents, were initially used to suppress inflammation by rheumatologists and gastroenterologists, and are now used in the treatment of psoriasis. Biological agents can be categorized broadly as T cell-targeted (e.g. efalizumab, alefacept) and cytokine-modulating (e.g. infliximab, etanercept). These biological agents do not appear to have significant organ toxicity and go some way to achieving the principal goal of management of severe psoriasis, which is disease clearance without risk.