BIOLOGIC THERAPY IN MODERATE-TO-SEVERE PSORIASIS: CURRENT EVIDENCE AND EMERGING TRENDS

Abstract

Psoriasis is a chronic, immune-mediated inflammatory skin disease affecting approximately 2–3% of the global population and is associated with significant physical, psychological, and socioeconomic burden. Moderate-to-severe psoriasis is characterized by extensive skin involvement, recurrent disease activity, impaired quality of life, and increased risk of multiple systemic comorbidities, including psoriatic arthritis, cardiovascular disease, metabolic syndrome, obesity, diabetes mellitus, and depression. Advances in the understanding of psoriasis immunopathogenesis have transformed therapeutic strategies through the development of biologic agents targeting specific inflammatory cytokines involved in disease progression. Tumor necrosis factor-alpha (TNF-α), interleukin-12/23 (IL-12/23), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitors have demonstrated remarkable efficacy in achieving sustained skin clearance, improving patient-reported outcomes, and reducing systemic inflammation. More recently, precision medicine, molecular biomarkers, pharmacogenomics, and artificial intelligence have emerged as promising tools for optimizing biologic selection, predicting treatment response, and individualizing long-term disease management. This review summarizes the current evidence regarding biologic therapy for moderate-to-severe psoriasis, highlighting mechanisms of action, clinical efficacy, safety, emerging biologic agents, and future perspectives in personalized dermatologic care.