Oral small molecules for psoriasis

Psoriasis is chronic inflammatory skin condition that imposes a significant physical and psychosocial burden on patients. Moderate to severe psoriasis often requires systemic treatments, including oral systemic therapies and biologics. An addition to the treatment repository for psoriasis is oral small molecules, which include apremilast, tofacitinib, and ponesimod. Of these 3 medications, only apremilast is currently approved for the treatment of psoriasis. Long-term safety data for apremilast suggest that it has a tolerable safety profile and leads to significant improvement in patients with psoriasis; however, there are few head-to-head comparisons with other oral systemic medications. Tofacitinib and ponesimod have demonstrated clinical efficacy in treating psoriasis; however, further studies are required to understand the benefit-risk profile of these medications in psoriasis patients.