Safetyconsiderationsinthechoiceoftreatment forpatients with psoriasis and psoriatic arthritis

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Both the efficacy and safety of treatment should be considered when choosing the medications for patients with psoriasis and psoriatic arthritis. Psoriatic disease is frequently associated with different comorbidities, i.e. diabetes mellitus, obesity, arterial hypertension, etc., that can limit treatment choices. The article reviews the safety profiles of different medications that are indicated for patients with psoriasis and psoriatic arthritis who do not respond to, do not tolerate or have contraindications to standard disease-modifying antiinflammatory drugs (DMARDs). Second-line treatments include phosphodiesterase 4 inhi bitor (apremilast), tumor necrosis factor alpha inhibitors, monoclonal antibodies to interleukins 12 and 23 (ustekinu mab) and interleukin 17A (sekukinumab). Apremilast is the first targeted synthetic DMARD for oral use that does not induce antibodies given its nonpeptide structure. All biologic agents increase the risk of infections and reactivation of latent tuberculosis. The results of clinical and retrospective studies suggest that treatment with apremilast is associated with a lower risk of infections.

Key words

Psoriasis, psoriatic arthritis, safety, TNF inhibitors, ustekinumab, secukinumab, apremilast.