Systemic Treatments for Chronic Plaque Psoriasis

Jack Cush, MD

Mar 25, 2026 6:57 pm

JAMA Dermatology has published a review of the pharmacologic landscape on managing adults with moderate to severe plaque psoriasis. Armstrong et al report on the efficacy (using the PASI 90) response and safety of these agents (including serious adverse events).

The authors show that biologic therapies, particularly interleukin (IL)–17 and IL-23 inhibitors, provide the highest short-term benefits (achieving PASI 90) compared to existing oral agents whichoffer modest efficacy. Overall, serious toxicities (severe adverse events) were uncommon across all therapies and similar to placebo in short term trials.

A recent Cochrane network meta-analysis examine 160 randomized clinical trials (57 611 psoriasis patients) to evaluate short-term comparative benefits and harms of systemic therapies. Results of the PASI 90 and serious adverse event rates occuring in the first 24 weeks of treatment were reported.

Systemic therapies were more effective than placebo in achieving PASI 90 during the induction period. In class-level analyses, interleukin (IL)–17 inhibitors demonstrated the highest efficacy, followed by biologics targeting IL-23, IL-12/23, and tumor necrosis factor α). Biologics outperformed targeted and nontargeted synthetic oral therapies.

Using the PASI 90, the best performing agents were infliximab, bimekizumab, ixekizumab, brodalumab, xeligekimab and risankizumab. Differences among these agents were small, suggesting broadly comparable short-term efficacy.

Overall, biologics, particularly IL-17 and IL-23 inhibitors, offered the most favorable balance of short-term efficacy and acceptability, whereas nontargeted oral therapies demonstrated substantially lower PASI 90 responses.

Systemic Pharmacological Treatments for Chronic Plaque Psoriasis