A practical guide to biologic treatments for psoriasis in resource-limited areas

Biologic therapies have transformed the management of moderate to severe psoriasis, providing targeted and effective interventions against key inflammatory pathways. Due to their action specifications compared to conventional therapies, they generally provide better efficacy-safety profiles, especially the second-generation of biologics for psoriasis. Furthermore, the broader aspects of patients' quality of life can improve dramatically. This review overviews the efficacy, safety, and real-world application of biologic agents, including tumor necrosis factor-alpha inhibitors, interleukin (IL)-12/23 inhibitors, IL-17 inhibitors and IL-23 inhibitors. Their effectiveness in difficult-to-treat areas such as the scalp, nails, palmoplantar region, and genital area, where conventional treatments often fail is also highlighted. Immunogenicity differences between biologics, along with variations in binding affinity and half-life, may influence treatment response and drug persistence. Intra-class and inter-class biologic switching have been utilized to optimize treatment outcomes in patients experiencing inadequate response or adverse effects. Long-term data suggest that biologics are well-tolerated, with a favorable safety profile. As biologic options continue to expand, individualized treatment selection such as patients' comorbidities, prior treatment history, and real-world drug survival are essential for optimizing patient outcomes in psoriasis management.