Does p40-targeted therapy represent a significant evolution in the management of plaque psoriasis?

The recognition of the roles of interleukins (IL)-12 and IL-23 in the development of psoriasis is an important advance in the understanding, and the subsequent management, of this chronic inflammatory disease. Two human anti-p40 monoclonal antibodies targeting both IL-12 and IL-23 via their shared p40 subunit have been developed: briakinumab and ustekinumab. Recent Phase 2 and Phase 3 trials have illustrated the benefits of briakinumab (in Phase 3 clinical development) and ustekinumab (approved in the EU, and also in other territories worldwide) in the treatment of moderate to severe plaque psoriasis. Available data indicate that a strategy targeting the IL-12 p40 subunit has considerable advantages over targeting of tumour necrosis factor-α, offering rapid onset of efficacy with a favourable dosing regimen (every 12 weeks for ustekinumab). Registries incorporating rigorous pharmacovigilance are now required to further understand the clinical profile of these drugs over long-term use.