Pharmaceutical Biotechnology and Comparative Efficacy of Biologic Therapies in Patients with Moderate-To-Severe Psoriasis: An Evaluation of Clinical Outcomes and Therapeutic Response

Abstract

Background. Moderate-to-severe plaque psoriasis is a chronic, immune-mediated inflammatory disease driven by the interleukin (IL)-23/IL-17 axis. Advances in pharmaceutical biotechnology have delivered successive generations of monoclonal antibodies that selectively neutralise tumour necrosis factor (TNF)-α, the shared p40 subunit of IL-12/IL-23, IL-17A, IL-17A/F and the p19 subunit of IL-23, transforming therapeutic expectations from partial improvement to complete skin clearance.
Objective. To synthesise and critically appraise the comparative efficacy of biologic therapies in adults with moderate-to-severe psoriasis, with emphasis on head-to-head randomised trials, network meta-analyses and the biotechnological rationale underlying each drug class.
Methods. A systematic literature review was conducted following PRISMA principles, searching the scientific discovery engines Scite and Consensus (indexing Semantic Scholar, OpenAlex and PubMed). Clinical response was appraised using validated outcomes —PASI 75/90/100, IGA/sPGA 0/1 and the Dermatology Life Quality Index (DLQI). An analytical corpus of 46 peer-reviewed studies (2007–2026) was retained.
Results. Head-to-head trials and network meta-analyses establish a broadly consistent efficacy hierarchy: IL-23p19 inhibitors (risankizumab, guselkumab) and the dual IL-17A/F inhibitor bimekizumab achieve the highest rates of PASI 90 and PASI 100, outperforming IL-12/23 inhibition (ustekinumab), TNF inhibitors and, for durability of response, the IL-17A inhibitors. IL-17A inhibition provides the most rapid onset, whereas IL-23 inhibition offers superior maintenance of response with infrequent dosing. Safety profiles are generally favourable and class-dependent.
Conclusions. Selective cytokine inhibition has made complete or near-complete skin clearance a realistic treatment target. Drug positioning should integrate speed of onset, durability, safety, comorbidities and patient-reported outcomes; the emergence of biosimilars is expected to broaden access, a consideration of particular relevance to resource-constrained settings.