INTRODUCTION
Moderate-to-severe psoriasis is associated with substantial burden, including increased depression and anxiety and reduced quality of life (QOL).1 Skin clearance with biologic therapies is associated with improved QOL; however, psoriatic disease may fail to respond to certain agents, leading to a lack of efficacy and disease recurrence and contributing to a frustrating cycle of treatment switching.2,3 Differences in the mechanism of action (MOA) of available therapies may result in various response rates and durability of responses, which lead to differential impact on QOL.3,4
Brodalumab is a fully human monoclonal antibody antagonist of the human interleukin-17 receptor A (IL-17RA) that is indicated for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies.5 Unlike other biologics that target specific IL-17 cytokines, brodalumab is the only approved biologic for psoriasis that binds IL-17RA, blocking signaling from multiple IL-17 family members, including IL-17A, IL-17C, IL-17E, IL-17F, and IL-17A/F.4 This comprehensive receptor-level blockade may contribute to brodalumab's clinical efficacy in patients after failed treatment with other targeted therapies, including IL-17 cytokine inhibitors, and may lead to improvements in QOL.6
This narrative review examines the humanistic burden of psoriasis, evaluating how complete and sustained skin clearance affects psychosocial outcomes and QOL, with a focus on brodalumab's unique MOA and its ability to improve dermatological and mental health outcomes, even in patients who have experienced prior biologic treatment failure. A graphical summary of this review is shown in Figure 1.
Patient Burden Associated With Psoriasis and Treatment Nonresponse
Disease Burden
Psoriasis has a profound negative impact on patients, from stigmatization to occupational challenges and mental health concerns.7 A survey of 514 patients with psoriasis showed that perceived stigmatization was experienced by 73% of patients.8 Stigmatization was associated with higher impact on daily life; lower education; higher disease visibility, severity, and duration; and higher levels of social inhibition.8
Additionally, psoriasis is associated with poor mental health outcomes, including depression, anxiety, suicidality, obsessive-compulsive behavior, somatization, and interpersonal sensitivity.1,9,10 Rates of depression can reach 34% among patients with psoriasis10 and are higher in men than women experiencing severe psoriasis and in younger vs older patients
