الفهرس 
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Abstract
Psoriasis is a chronic, systemic, immune-mediated inflammatory skin disease of unknown etiology, however, several cytokines were reported to share in the pathogenesis of psoriasis as IL-12, IL- 23 and TNF-α. Biologics targeting these cytokines showed effective results in treatment of psoriasis patients. However, long term efficacy and tolerability of these agents is still questionable.
In the current study we compared the efficacy and safety of anti-TNF alpha and anti IL12/23 in moderate to severe psoriasis over long periods of treatment in order to complete the efficacy and safety profile of biologic therapies.
Regarding rate of PASI 75 at year 1, IL-12/23 inhibitors have a greater probability of achieving a PASI 75 response than anti-TNF alpha, with the pooled PASI 75 estimate at 84% and 76.18%, respectively. While, regarding rate of PASI 75 at year 2, 3, 4 and 5, there are no studies that assess the PASI 75 at year 2 or more for anti-TNF. The PASI 75 at years 2, 3, and 5 for IL-12/23 inhibitors appeared to be stable at about 80 %, while it reached 91% at year 4.
Rate of serious infections was 2.9% and 2.4% with anti-TNF alpha and IL-12/23 inhibitors respectively. There was showing no significant difference in the risk of serious infection between the two classes. In the current study, the rate of malignancy showed no-significant difference in psoriatic patients as patients receiving anti-TNF-alpha had 3.7% rate
Summary
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while in patients receiving IL 12/23 inhibitors the rate was 3.9%.
Rate of MACEs, in psoriatic patients initiating IL12/23 inhibitors and those initiating anti-TNF alpha, of 1.18 and 1.8 respectively. This revealed insignificant risk of MACEs with IL12/23 inhibitors and a slight increased risk with anti-TNF alpha.
In the current study rate of common adverse events in patients receiving anti-TNF-alpha was significantly compared to patients receiving IL 12/23 inhibitors (25.77% and 9.22% respectively).