Presentation during International Medical Student Congress in Poznań. 1st award in dermatology session.

1. Effectiveness of TNF-α blockers and
IL-12/IL-23 blockers in the treatment of
Psoriasis.
Preliminary observations.
Wojciech Francuzik, Kinga Byczkowska
Student working group
at The Clinic of Skin Diseases and Medical Mycology,
Poznań University of Medical Sciences.
Supervisor: Professor Zygmunt Adamski MD PhD

2. Biological Agents
● Used in dermatology, rheumatology and
gastroenterology
● Block pathways of inflammtion
pharmatching.com

3. Interleukin IL-12 in the pathogenesis of
psoriasis
Dendritic Cells
Macrophages
Keratinocytes
Mast cells
Granulocytes
Th0
Th1
NK
Other
cytokines
IgG
IL-12

4. Interleukin IL-23 in the pathogenesis of
psoriasis
Langerhans C
Macrophages
Keratinocytes
Th17
Th17
activ
e
Induce
s
CD8+
cytotoxicit
y
IL-23

5. TNF-α in the pathogenesis of psoriasis
Langerhans C
Macrophages
Keratinocytes
Mast cells
● Elevated concentration in changed skin
● Induces migration of macrophages
● Stimulates LC maturation
● Stimulates proinflammatory cytokines production
● Induces proliferation of keratinocytes

6. Structure of cytokines important in the
pathogenesis of psoriasis
Nature Reviews Immunology
TNF-α
Acts trough:
TNF-RI
TNF-RII
Current Protocols.com

7. The agents used in the treatment of
psoriasis
Infliximab Etanercept Adalimumab Ustekinumab
Chimeric
antibody
Human
antibody
Human
fusion protein
Human
antibody
TNF-α blockers
IL-12, IL-23
Blocker
p40 subunit
i.v. 5mg/kg
0-2-4-8 w
Than every 8 w
s.c. 50 mg
Every week
i.m. 40 mg
Every 2 weeks
s.c. 45mg
0-4-12 w
Than every 12 w

8. Aim of this study:
To verify which biologic agent (infliximab,
adalimumab, etanercept, ustekinumab) used in
the treatment of psoriasis is the most effective
in reducing skin changes.

9. Materials and methods:
51 psoriatic patients
Infliximab Etanercept Adalimumab Ustekinumab
15 12 11 13
PASI 0
(at day 0)
PASI 0
(at day 0)
PASI 0
(at day 0)
PASI 0
(at day 0)
After 4 weeks
of therapy
PASI 4 PASI 4 PASI 4 PASI 4
After 12 weeks
of therapy
PASI 12 PASI 12 PASI 12 PASI 12

10. ● Calculating a percentile PASI reduction after 4
weeks of therapy
● Calculating a percentile PASI reduction after 12
weeks of therapy
Materials and methods:
Pred4=
PASI 4
PASI 0
Pred12=
PASI 12
PASI 0

11. Results:
● There is a difference beetween means in the 4 agents
groups during fist 4 weeks of treatment
P=0.0196 (Kruskal-Wallis test)
I: infliximab, E: etanercept, A: adalimumab, U: ustekinumab

12. Results:
● There was a difference beeteween means of Pred4
between groups treated with etanercept and
adalimumab
P=0.0074 (Mann Whitney test)
Etanercept group mean = 51,42%
Adalimumab group mean = 72,00%
● There was a difference beeteween means of Pred4
between groups treated with etanercept and
infliximab P=0.0089 (Mann Whitney test)
Infliximab group mean = 73,07%
Etanercept group mean = 51,42%

13. Results:
● There was NO difference beeteween means of Pred4
inside each group considering common psoriasis and
psoriatic arthritis patients
● There was NO difference beeteween means of Pred4
inside each group considering patients with family
history of psoriasis and those without
● There was NO difference beeteween means of Pred12
between all groups
P=0.5238 (Kruskal-Wallis test)

14. Results:
● There was difference beeteween means of Pred4
between male and female patients in infliximab
group P=0,0077 (Mann Whitney test)
Im: infliximab in males, Ik: ifliximab in females

15. Results:
● There was difference beteween means of Pred4
between male patients in all groups.
● Significant difference was observed between
infliximab, etanercept and adalimumab groups.
I: infliximab, E: etanercept, A: adalimumab, U: ustekinumab, m for male patients

16. Infliximab treated
group

17. Adalimumab treated group

18. Conclusion
● The effectiveness of reducing PASI score was most
rapidly seen in infliximab group
● Etanercept group had longer response to therapy
time
● All agents were equally effective in reducing skin
changes during 12 weeks of treatment
● Male patients seamed to respond faster to Infliximab
than female patients.
● Male patients showed more varied response to
different agents than female patients

19. Thanks to:
● Professor Zygmunt Adamski MD PhD
● Staff of the Skin Disease Department of The
Regional Hospital in Poznań
Immunologia, Gołąb J, Jakóbisiak M, Lasek W (red.).
PWN Warszawa 2004
Tracey D, Klareskog L, Sasso EH et al. Tumor necrosis factor
antagonist mechanism of action: a comprehensive review.
Pharmacol Ther 2008; 117:224-79
Krueger JG. The immunologic basis for the treatment of psoriasis
with new biologic agents. J Am Acad Dermatol 2002; 25: 20-33
Liebwohl MG, Use of Etanercept in the dermatology setting.
Am J Acad Dermatol 2005; 6: 49-59