The Evolution of Biologic Therapies for Psoriasis and Atopic Dermatitis: A Systematic Review of Randomized Controlled Trial
DOI:
https://doi.org/10.19166/med.v15i2.10975Keywords:
Atopic dermatitis, Biologics, Psoriasis, Systematic reviewAbstract
ground:
Psoriasis and atopic dermatitis are chronic, immune-mediated inflammatory skin diseases that cause a substantial, lifelong burden on patients globally. Over the past two decades, the therapeutic paradigm has shifted dramatically from broad immunosuppression to highly targeted biologic therapies designed to interrupt key cytokine pathways driving clinical disease activity.
Methods:
To comprehensively evaluate this transition, we conducted a systematic review of randomized controlled trials assessing the efficacy and safety of biologic treatments for moderate-to-severe psoriasis and atopic dermatitis. We systematically searched major electronic databases for peer-reviewed published trials, extracting data on targeted mechanisms, clinical efficacy outcomes, and safety profiles.
Result:
The evolution in psoriasis treatment progressed sequentially from early tumor necrosis factor inhibitors to highly specific interleukin (IL)-12/23, IL-17, and selective IL-23 blockades. These newer agents consistently demonstrate unprecedented rates of complete skin clearance and durable responses. Similarly, the atopic dermatitis landscape has been revolutionized by biologics targeting type 2 inflammation, particularly the IL-4 and IL-13 pathways. These interventions provide profound relief from intractable pruritus and persistent lesions in patients refractory to conventional therapies, while largely avoiding the off-target toxicities of older systemic agents.
Conclusions:
The advent and evolution of biologic therapies represent a watershed moment in dermatology. By enabling precision immunology, these targeted treatments have fundamentally transformed disease management, offering patients realistic expectations for sustained remission and significantly enhanced quality of life.
References
1. Courtney, A., & Su, J. C. (2024). The Psychology of Atopic Dermatitis. Journal of Clinical Medicine, 13(6), 1602. https://doi.org/10.3390/jcm13061602
2. Fang, J., Chen, G., Wu, M., Shi, Y., Yuan, C., & Liu, W. (2026). Trends and projections of dermatitis burden (1990-2040): A 2021 global burden of disease analysis. Frontiers in Medicine, 13, 1696683. https://doi.org/10.3389/fmed.2026.1696683
3. Karmbir, null, Faisal, S. M., Narang, R. K., Kurmi, B. D., Kaur, K., & Sharma, A. (2026). Psoriasis beyond the skin: Systemic inflammation as a bridge to metabolic and hepatic comorbidities. Inflammopharmacology. https://doi.org/10.1007/s10787-025-02027-y
4. Kakarala, C. L., Hassan, M., Belavadi, R., Gudigopuram, S. V. R., Raguthu, C. C., Gajjela, H., Kela, I., & Sange, I. (2021). Beyond the Skin Plaques: Psoriasis and Its Cardiovascular Comorbidities. Cureus. https://doi.org/10.7759/cureus.19679
5. Hawkes, J. E., Yan, B. Y., Chan, T. C., & Krueger, J. G. (2018). Discovery of the IL-23/IL-17 Signaling Pathway and the Treatment of Psoriasis. Journal of Immunology, 201(6), 1605–1613. https://doi.org/10.4049/jimmunol.1800013
6. Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.), 372, n71. https://doi.org/10.1136/bmj.n71
7. Thaçi, D., Blauvelt, A., Reich, K., Tsai, T.-F., Vanaclocha, F., Kingo, K., Ziv, M., Pinter, A., Hugot, S., You, R., & Milutinovic, M. (2015). Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis: CLEAR, a randomized controlled trial. Journal of the American Academy of Dermatology, 73(3), 400–409. https://doi.org/10.1016/j.jaad.2015.05.013
8. Reich, K., Warren, R. B., Lebwohl, M., Gooderham, M., Strober, B., Langley, R. G., Paul, C., De Cuyper, D., Vanvoorden, V., Madden, C., Cioffi, C., Peterson, L., & Blauvelt, A. (2021). Bimekizumab versus Secukinumab in Plaque Psoriasis. New England Journal of Medicine, 385(2), 142–152. https://doi.org/10.1056/NEJMoa2102383
9. Reich, K., Gooderham, M., Thaçi, D., Crowley, J. J., Ryan, C., Krueger, J. G., Tsai, T.-F., Flack, M., Gu, Y., Williams, D. A., Thompson, E. H. Z., & Paul, C. (2019). Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): A randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet, 394(10198), 576–586. https://doi.org/10.1016/S0140-6736(19)30952-3
10. Papp, K. A., Langley, R. G., Lebwohl, M., Krueger, G. G., Szapary, P., Yeilding, N., Guzzo, C., Hsu, M.-C., Wang, Y., Li, S., Dooley, L. T., Reich, K., & PHOENIX 2 study investigators. (2008). Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet, 371(9625), 1675–1684. https://doi.org/10.1016/S0140-6736(08)60726-6
11. Menter, A., Tyring, S. K., Gordon, K., Kimball, A. B., Leonardi, C. L., Langley, R. G., Strober, B. E., Kaul, M., Gu, Y., Okun, M., & Papp, K. (2008). Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. Journal of the American Academy of Dermatology, 58(1), 106–115. https://doi.org/10.1016/j.jaad.2007.09.010
12. Leonardi, C. L., Kimball, A. B., Papp, K. A., Yeilding, N., Guzzo, C., Wang, Y., Li, S., Dooley, L. T., Gordon, K. B., & PHOENIX 1 study investigators. (2008). Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet, 371(9625), 1665–1674. https://doi.org/10.1016/S0140-6736(08)60725-4
13. Langley, R. G., Elewski, B. E., Lebwohl, M., Reich, K., Griffiths, C. E. M., Papp, K., Puig, L., Nakagawa, H., Spelman, L., Sigurgeirsson, B., Rivas, E., Tsai, T.-F., Wasel, N., Tyring, S., Salko, T., Hampele, I., Notter, M., Karpov, A., Helou, S., … FIXTURE Study Group. (2014). Secukinumab in plaque psoriasis—Results of two phase 3 trials. The New England Journal of Medicine, 371(4), 326–338. https://doi.org/10.1056/NEJMoa1314258
14. Langley, R. G., Elewski, B. E., Lebwohl, M., Reich, K., Griffiths, C. E. M., Papp, K., Puig, L., Nakagawa, H., Spelman, L., Sigurgeirsson, B., Rivas, E., Tsai, T.-F., Wasel, N., Tyring, S., Salko, T., Hampele, I., Notter, M., Karpov, A., Helou, S., & Papavassilis, C. (2014). Secukinumab in Plaque Psoriasis—Results of Two Phase 3 Trials. New England Journal of Medicine, 371(4), 326–338. https://doi.org/10.1056/NEJMoa1314258
15. Feldman, S. R., Gordon, K. B., Bala, M., Evans, R., Li, S., Dooley, L. T., Guzzo, C., Patel, K., Menter, A., & Gottlieb, A. B. (2005). Infliximab treatment results in significant improvement in the quality of life of patients with severe psoriasis: A double-blind placebo-controlled trial. British Journal of Dermatology, 152(5), 954–960. https://doi.org/10.1111/j.1365-2133.2005.06510.x
16. Zhang, L., Peng, G., Wang, M., Niyonsaba, F., & Gao, X. (2025). Beyond the blockade: Unmet needs in systemic targeted atopic dermatitis therapy. Frontiers in Immunology, 16, 1712757. https://doi.org/10.3389/fimmu.2025.1712757
17. Xue, J., & Yao, Z. (2025). Antisense molecules: A promising new therapy for atopic dermatitis. Acta Pharmaceutica Sinica B, 15(11), 5493–5514. https://doi.org/10.1016/j.apsb.2025.09.008
18. Zhu, Q., Zhao, L., Ding, H., Song, J., Zhang, Q., Yu, S., Wang, Y., & Wang, H. (2024). Interleukins and Psoriasis. Journal of Cutaneous Medicine and Surgery, 28(2), NP19–NP35. https://doi.org/10.1177/12034754241227623
19. Drakos, A., Torres, T., & Vender, R. (2024). Emerging Oral Therapies for the Treatment of Psoriasis: A Review of Pipeline Agents. Pharmaceutics, 16(1), 111. https://doi.org/10.3390/pharmaceutics16010111
20. Brembilla, N. C., & Boehncke, W.-H. (2023). Revisiting the interleukin 17 family of cytokines in psoriasis: Pathogenesis and potential targets for innovative therapies. Frontiers in Immunology, 14, 1186455. https://doi.org/10.3389/fimmu.2023.1186455
21. Bianco, M., D’Oria, F., Falcidia, C., Foggi, G., Matteodo, E., Di Giulio, S., Facheris, P., Ibba, L., Perugini, C., Valenti, M., Vignoli, C. A., Costanzo, A., Narcisi, A., & Gargiulo, L. (2025). New and Emerging Biologics and Jak Inhibitors for the Treatment of Prurigo Nodularis: A Narrative Review. Medicina, 61(4), 631. https://doi.org/10.3390/medicina61040631
22. Sahni, V. N., Balogh, E. A., Strowd, L. C., & Feldman, S. R. (2022). The evolving atopic dermatitis management landscape. Expert Opinion on Pharmacotherapy, 23(4), 517–526. https://doi.org/10.1080/14656566.2021.1999412
23. Saeki, H., Ohya, Y., Furuta, J., Arakawa, H., Ichiyama, S., Katsunuma, T., Katoh, N., Tanaka, A., Tsunemi, Y., Nakahara, T., Nagao, M., Narita, M., Hide, M., Fujisawa, T., Futamura, M., Masuda, K., Matsubara, T., Murota, H., & Yamamoto‐Hanada, K. (2022). English Version of Clinical Practice Guidelines for the Management of Atopic Dermatitis 2021. The Journal of Dermatology, 49(10). https://doi.org/10.1111/1346-8138.16527
24. Jeskey, J., Kurien, C., Blunk, H., Sehmi, K., Areti, S., Nguyen, D., & Hostoffer, R. (2024). Atopic Dermatitis: A Review of Diagnosis and Treatment. The Journal of Pediatric Pharmacology and Therapeutics, 29(6), 587–603. https://doi.org/10.5863/1551-6776-29.6.587
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Copyright (c) 2026 Claudia Felicia Limanda, Ericko Hartanto, Elisa Putri, Nurzanah Primadani, Multiyus Hasnah

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