Review Article

Beyond Biologics: Non-Biologic Systemic Treatments for Psoriasis-A Narrative Review

  • Sazia Afrin1, Md. Saiful Islam Bhuiyan2, Asma Sharmin3, Emily Akter4, Alok Kumar Sarkar5

  • Volume 5, Issue 2, Page No: 30-37

Author Details

1. Bangladesh Medical College, Dhaka, Bangladesh

2. Bangladesh Medical University (BMU) , Dhaka, Bangladesh

3. Upzilla Health Complex Rupganj, Narayanganj, Bangladesh

4. Shaheed Monsur Ali Medical College, Dhaka, Bangladesh

5. Jashore Medical College Hospital, Jashore, Bangladesh


Abstract

Background: Psoriasis is a chronic immune-mediated disorder affecting 2–3% of the global population. Although biologic therapies have transformed treatment paradigms, a substantial proportion of patients require or prefer non-biologic systemic therapies due to cost constraints, comorbidities, access limitations, pregnancy planning, or personal choice—particularly in resource-limited settings including Bangladesh where tuberculosis and hepatitis B coinfection remain prevalent. Objective: To comprehensively review the efficacy, safety, monitoring requirements, and clinical application of non-biologic systemic treatments for psoriasis across diverse healthcare settings. Methods: Narrative review of current evidence from clinical trials, guidelines, and real-world studies on systemic psoriasis therapy excluding biologics. Key Findings: Methotrexate, cyclosporine, and acitretin remain foundational therapies with robust long-term clinical experience. Modern small molecules—including apremilast, dimethyl fumarate, and the emerging TYK2 inhibitor deucravacitinib—offer improved safety profiles and reduced monitoring burden. Treatment selection requires individualized evaluation of disease severity, comorbidities, reproductive considerations, and patient accessibility. Conclusion: Non-biologic systemic therapies remain essential tools in managing moderate-to-severe psoriasis globally. These agents provide cost-effective, flexible alternatives to biologics, with ongoing development of targeted oral therapies expanding therapeutic options. Judicious selection based on clinical phenotype and patient-specific factors optimizes outcomes while minimizing adverse effects.

Keywords: Psoriasis, systemic therapy, methotrexate, cyclosporine, apremilast, deucravacitinib, non-biologic therapy, small molecules


Keywords: Psoriasis, Systemic Therapy, Methotrexate, Cyclosporine, Apremilast, Deucravacitinib, Non-Biologic Therapy, Small Molecules

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