What drug class would you use to treat active psoriasis and psoriatic arthritis with axial involvement in patients on immunosuppression for other indications (e.g., tacrolimus for a liver transplant)?

Organ transplant recipients are immunocompromised due to their transplant rejection regimen and thus require a careful risk-benefit discussion prior to treatment with a biologic agent. I would consider two things prior to initiation of biologic therapy: how recent was the transplant and how active is the disease as at times the transplant rejection medications 'might' be helpful in treating the primary rheumatic disease.

For a patient with active psoriasis and psoriatic arthritis with axial involvement, I would prefer to use an IL-17 A inhibitor. The MAXIMISE study was an RCT that showed the benefits of using secukinumab in patients with axial PsA. In the study, 63.1% and 66.3% on secukinumab 300 mg and 150 mg achieved ASAS20 responses comp...