Concept of dual immune inhibitors for the treatment of drug-resistant psoriatic disease

Abstract

Biologic therapies have significantly improved the management of immune-mediated conditions like psoriatic disease, enhancing the quality of life of patients. However, monotherapy is often insufficient, especially in cases of relapse, concomitant psoriatic arthritis, and involvement of difficult-to-treat areas: the scalp, palmoplantar areas, inverse regions, or genital areas. Patients with psoriatic disease also exhibit varying responses in their skin and joint manifestations to the same biologic, making dual biologic therapy a potential solution. Psoriasis is increasingly recognized as a systemic disease affecting multiple organs, and given the complex pathophysiology, different organs may respond differently to treatment. Targeting multiple immune mediators simultaneously could therefore lead to more effective disease control. Common combinations include TNF inhibitors with IL-17/23 antagonists. Despite its potential, dual biologic therapy remains infrequent, with most data coming from clinical case reports. This review explores dual immune inhibition as a therapeutic strategy, its rationale, and limitations for drug-resistant psoriatic disease.