Psoriasis impairs significantly the quality of life. Systemic treatments have inconstant efficiency and dose-dependant toxicity. Since 2004, four biologic therapies - infliximab, etanercept, éfalizumab and adalimumab - are approved in Europe for the treatment of moderate to severe psoriasis, with failure, intolerance or contra-indication to at least 2 "classical" systemic treatments, including phototherapy, methotrexate and ciclosporin. The estimated rate of patients reaching PASI75 at month 3 are as follow: about 80% under infliximab (classical W0-W2-W6 regimen); about 33% and 50% under etanercept, respectively, 25 and 50mg, twice weekly; about 25% under éfalizumab (1mg/kg, weekly); about 70% under adalimumab (40mg, every other week). The 12-month efficiency of biologic therapies in psoriasis is poorly documented. The long term (5-year or more) safety of biologic therapies is not documented. New biologic therapies are under investigation in the treatment of psoriasis: ustekinumab (CNTO-1275), ABT-874, certolizumab (CDP-870), golimumab (CNTO-148). Ustekinumab is approved in Europe since January 2009.
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