Published: 2019-10-21

Biologics in dermatology

Abhishek D. Oka, Tanvi P. Vaidya, Prashant Potdar


The role of biologicals in dermatology has seen an exponential growth in the last few years. Biologicals such as TNF-alpha inhibitors have now lost their novelty and are routinely used all over the world. As the pathogenesis of various diseases is now being understood better, we have been able to create more targeted biological therapies for a number of dermatological conditions. We attempt to compile an update on the newer biologicals in use today, and briefly touch upon the older ones as well. We conducted an extensive literature search and have covered TNF-alpha inhibitors, molecules against T cell receptors, Janus Kinase inhibitors, interleukin based molecules, fusion proteins, and some newer biologicals as well. Their mechanisms of action, indications and dosage have been covered in our review.


Biologicals, Monoclonal antibodies, Targeted therapy

Full Text:



Arend WP. The mode of action of cytokine inhibitors. J Rheumatol. 2002;65:16-21.

Demirtasoglu M, Emel Fetil. The Use of Infliximab in Dermatology. Antiinflamm Antiallergy Agents Med Chem. 2008;

Sehgal VN, Pandhi D, Khurana A. Biologics in dermatology: An integrated review. Indian J Dermatol. 2014;59:425-41.

Traczewski P, Rudnicka L. Adalimumab in dermatology. Br J Clin Pharmacol. 2008;66(5):618-25.

Richardson S, Getfand J. Immunobiologicals, cytokines and growth factors in dermatology. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's dermatology in general medicine. 7th ed. McGraw - Hill; 2008: 2223-2231.

Tzu J, Mamelak AJ, Sauder DN. Current advancements in the treatment of psoriasis: Immunobiologic agents. Clin Appl Immunol Rev. 2006;6:99-130.

Langley R, Roenigk HH, McCall C. Phase I results of intravenous MEDI-507, anti-T-cell monoclonal antibody, for the treatment of psoriasis. J Invest Dermatol. 2001;117:817.

Gottlieb AB, Lebwohl M, Shirin S, Sherr A, Gilleaudeau P, Singer G, et al. Anti-CD4 monoclonal antibody treatment of moderate to severe psoriasis vulgaris: Results of a pilot, multicenter, multiple-dose, placebo-controlled study. J Am Acad Dermatol. 2000;43:595-604.

Anandan V, Jameela WA, Sowmiya R, Kumar MMS, Lavanya P. Rituximab: a magic bullet for pemphigus. J Clin Diagn Res. 2017;11(4):WC01-6.

Reguiai Z, Tabary T, Maizieres M, Bernard P. Rituximab treatment of severe pemphigus: long-term results including immunologic follow-up. J Am Acad Dermatol. 2012;67(4):623-9.

Owen CM, Harrison PV. Successful treatment of severe psoriasis with basiliximab: An interleukin-2 receptor monoclonal antibody. Clin Exp Dermatol. 2000;25:195-7.

Dichmann S, Mrowietz U, Schopf E, Norgauer J. Humanized monoclonal anti-CD25 antibody as a novel therapeutic option in HIV-associated psoriatic erythroderma. J Am Acad Dermatol. 2002;47:635-6.

Gottlieb AB, Kang S, Linden KG, Lebwohl M, Menter A, Abdulghani AA, et al. Evaluation of safety and clinical activity of multiple doses of the anti-CD80 monoclonal antibody, galiximab, in patients with moderate to severe plaque psoriasis. Clin Immunol. 2004;111:28-37.

Coondoo A. Biologics in dermatologic therapy - An update. Indian J Dermatol. 2009;54:211-20.

Beck, L.A. et al. Dupilumab treatment in adults with moderate‐to‐severe atopic dermatitis. N Engl J Med. 2014;371:130-9.

Abonia JP, Putnam PE. Mepolizumab in eosinophilic disorders. Expert Rev Clin Immunol. 2011;7(4):411-7.

Krueger GC, Lohner M, Roskos L, Hwang CC, Bell G, Schwab G. Clinical trials results: a fully human anti-IL-8 antibody in patients with moderate to severe psoriasis. Poster presented at: annual meeting of the American Academy of Dermatol. Washington, DC, 2001.

Traczewski P, Rudnicka L. Briakinumab for the treatment of plaque psoriasis. BioDrugs. 2012;26(1):9-20.

Brightling CE, Chanez P, Leigh R, O'Byrne PM, Korn S, She D, et al. Efficacy and safety of tralokinumab in patients with severe uncontrolled asthma: a randomised, double-blind, placebo-controlled, phase 2b trial. Lancet Respir Med. 2015;3:692-701.

Simpson EL, Flohr C, Eichenfield LF, Bieber T, Sofen H, Taïeb A, et al. Efficacy and safety of lebrikizumab (an anti-IL-13 monoclonal antibody) in adults with moderate-to-severe atopic dermatitis inadequately controlled by topical corticosteroids: A randomized, placebo-controlled phase II trial (TREBLE). J Am Acad Dermatol. 2018;78(5):863-71.

Wasilewska A, Winiarska M, Olszewska M, Rudnicka L. Interleukin-17 inhibitors. A new era in treatment of psoriasis and other skin diseases. Postepy Dermatol Alergol. 2016;33(4):247-52.

Cosentyx. Prescribing information. Novartis Pharmaceutical Corporation. Available at: Accessed on 3 June 2019.

SILIQ (prescribing information). Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2017.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Ixekizumab (Psoriasis Arthritis) - Benefit assessment according to §35a Social Code Book V. Dossier assessment;Commission A18-14. (IQWiG reports; Volume 631), 2018.

Blauvelt A, Papp KA, Griffiths CEM, Randazzo B, Wasfi Y, Shen Y-K, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405-17.

Papp KA, Blauvelt A, Bukhalo M, Gooderham M, Krueger JG, Lacour JP, et al. Risankizumab versus ustekinumab for moderate-to-severe plaque psoriasis. N Engl J Med. 2017;376:1551-60.

Reich K, Papp KA, Blauvelt A, Tyring SK, Sinclair R, Thaçi D, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet. 2017;390:276-88.

Ilumya. Prescribing information. Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc; 2018.

Saito T, Iida S, Terao K, Kumagai Y. Dosage Optimization of Nemolizumab Using Population Pharmacokinetic and Pharmacokinetic-Pharmacodynamic Modeling and Simulation. J Clin Pharmacol. 2017;57(12):1564-72.

Bubna AK. Janus Kinase Inhibitors in Dermatology. Indian J Drugs Dermatol. 2019;5:6-13.

Vandiver A, Girardi N, Alhariri J, Garza LA. Two cases of alopecia areata treated with ruxolitinib: a discussion of ideal dosing and laboratory monitoring. Int J Dermatol. 2017;56(8):833-5.

Liu LY, Craiglow BG, Dai F, King BA. Tofacitinib for the treatment of severe alopecia areata and variants: A study of 90 patients. J Am Acad Dermatol. 2017;76(1):22-8.

Jabbari A, Dai Z, Xing L, Cerise JE, Ramot Y, Berkun Y, et al. Reversal of alopecia areata following treatment with the JAK1/2 inhibitor baricitinib. EBioMedicine. 2015;2(4):351-5.

Vanhoutte F, Mazur M, Voloshyn O, Stanislavchuk M, Van der Aa A, Namour F, et al. Efficacy, safety, pharmacoki-netics, and pharmacodynamics of filgotinib, a selective JAK-1 inhibitor, after short-term treatment of rheumatoid arthritis: results of two random-ized phase IIa trials. Arthritis Rheumatol. 2017;69(10):1949-59.

Genovese MC, van Vollenhoven RF, Pacheco-Tena C, Zhang Y, Kinnman N. VX-509 (Decernotinib), an oral selective JAK-3 inhibitor, in combination with methotrexate in patients with rheumatoid arthritis. Arthritis Rheumatol. 2016;68(1):46-55.

Parmentier J, Voss J, Graff C, Schwartz A, Argiriadi M, Friedman M, et al. In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494). BMC Rheumatol, 2018;2(1):1.

Papp K. Clinical development of onercept, a tumor necrosis factor binding protein, in psoriasis. Curr Med Res Opin. 2010;26:2287-300.

Lamore R, Parmar S, Patel K, Hilas O. Belimumab (benlysta): a breakthrough therapy for systemic lupus erythematosus. P T. 2012;37(4):212-26.

Kaufman HL, Russell J, Hamid O, Bhatia S, Terheyden P, D’Angelo SP, et al. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol 2016;17:1374-85.

Corren J, Parnes JR, Wang L, Mo M, Roseti SL, Griffiths JM, van der Merwe R. Tezepelumab in adults with uncontrolled asthma. N Engl J Med. 2017;377(10):936-46.

Banerji A, Riedl MA, Bernstein JA, Cicardi M, Longhurst HJ, Zuraw BL, et al. Effect of lanadelumab compared with placebo on prevention of hereditary angioedema attacks: a randomized clinical trial. JAMA. 2018;320(20):2108-21.

TAKHZYRO (lanadelumab). Summary of Product Characteristics. Rentschler Biopharma SE. November 2018. Available at: https://www.ema. Accessed on 3 June 2019.

Hassan I, Aleem S, Sheikh G, Anwar P. Biologics in Dermatology: A Brief Review. BJMP 2013;6(4):a629.

Prashant S, Dennis PW, Kenneth BG. Biologic Therapy for Psoriasis, The New Therapeutic Frontier. Arch Dermatol. 2002;138: 657-63.

Bolinger A, Taeubel MA. Recombinant interferon gamma for treatment of chronic granulomatous disease and other disorders. Clin Pharm. 1992;11;834-50.

Dalakas MC. The use of intravenous immunoglobulin in the treatment of autoimmune neuromuscular diseases: evidence-based indications and safety profile. Pharmacol Ther. 2004;102(3):177-93.