Investigational VEGF antagonists for psoriasis

Introduction: Vascular endothelial growth factor (VEGF) mediates angiogenesis consequent to binding to VEGF receptors (VEGFRs) and is upregulated in patients with psoriasis. VEGF is also upregulated in other diseases characterised by angiogenesis including proliferative retinopathy and cancer. Several VEGF antagonists have been approved for the treatment of these conditions and may also have the potential to treat psoriasis. Areas covered: A PubMed literature search was performed to identify preclinical and clinical research regarding investigational VEGF antagonists for the treatment of psoriasis. Various agents have been reviewed including monoclonal antibodies against VEGF and VEGFRs, decoy anti-VEGF receptors and tyrosine kinase inhibitors that block the effects of VEGF/VEGFR binding. Expert opinion: Several investigational drugs have demonstrated potential to treat psoriasis. Clinical observations of psoriasis remission following administration of bevacizumab, sunitinib and sorafenib in cancer patients are encouraging. Of particular interest is a novel anti-VEGF/anti-TNF-alpha decoy receptor (Valpha), whose dual action could be beneficial given the numerous pathogenetic pathways in psoriasis. A topical tyrosine kinase inhibitor also has potential given the cost and safety advantages conferred by this mode of administration. More research is warranted both in the prototypical drugs and in those already marketed for other indications.