ABSTRACT
One clinical method of evaluating immunocompetence is monitoring infection rates. Many laboratory parameters of systemic immunity appear not to be suppressed by biologic therapy, including various serum immune cell populations and T-cell response to antigen stimulation. Biologic therapy decreases the cell populations and cytokines characteristic of the Th17 pathway close to, but not below, levels of healthy controls. Given the biologic medications in psoriasis target a specific pathway that is hyperactive at baseline, use of the term “immunosuppressant” may be misleading. When used to treat psoriasis, alternative terms, such as “anti-inflammatory” can be considered to describe these agents. The only evidence-based effect of biologic agents in decreasing immune function below that of untreated controls appears to be limited to granulomatous disease. The clearly increased risk associated with anti-tumor necrosis factor agents appears to be limited to granulomatous disease.
