Comparative Analysis of biologic therapy for psoriasis versus Standard Care in plaque psoriasis

Jun Yang; B. Yang; F. Huang

doi:10.5281/zenodo.22814266

Authors

Jun Yang Department of Clinical Dermatology, Tajo Academy of Dermatology Author https://orcid.org/7404-5713-5848-7240
B. Yang Division of Dermatology, Nile Center for Cosmetic and Aesthetic Surgery Author https://orcid.org/6716-5632-2085-7190
F. Huang Department of Dermatology, Murray Institute for Advanced Cosmetic and Aesthetic Surgery Author https://orcid.org/1574-2763-0157-9221

DOI:

https://doi.org/10.5281/zenodo.22814266

Keywords:

plaque psoriasis, biologic therapy, TNF-alpha inhibitors, IL-17/IL-23 inhibitors, PASI response

Abstract

Graphical abstract

Background: Plaque psoriasis is a chronic immune-mediated skin disease for which biologic agents targeting tumor necrosis factor-alpha, interleukin-12/23, interleukin-17, and interleukin-23 have progressively supplemented conventional systemic care.

Objective: This review compares the efficacy, safety, and practical positioning of biologic therapy against standard care, including phototherapy, methotrexate, and cyclosporine, in adults with moderate-to-severe plaque psoriasis.

Methods: We synthesized pivotal randomized controlled trials, head-to-head biologic comparisons, network meta-analyses, and long-term registry studies reporting Psoriasis Area and Severity Index response, drug survival, safety outcomes, and cost-effectiveness.

Findings: Biologic agents consistently achieved higher rates of skin clearance than conventional systemic therapy, with response rates rising across successive drug classes from tumor necrosis factor-alpha inhibitors through interleukin-17 and interleukin-23 inhibitors; long-term registry data showed comparable or better tolerability and longer treatment persistence for biologic agents relative to conventional therapy, while acquisition cost remained the principal factor favoring standard care.

Conclusions: Biologic therapy offers superior and more durable disease control than standard care in moderate-to-severe plaque psoriasis, and its comparative advantage over conventional systemic agents is now supported by a broad and consistent evidence base, though cost and access continue to shape real-world treatment sequencing.

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