Anti-IL 23 biologics for the treatment of plaque psoriasis

ABSTRACT

Introduction

Psoriasis is a chronic inflammatory disease that can drastically affect a patient’s quality-of-life and is associated with multiple comorbid conditions. The most common form of psoriasis is plaque psoriasis, commonly presenting as sharply demarcated, erythematous plaques with overlying silvery scale on the trunk, extensor surfaces, limbs, and scalp. Although initially limited to oral therapies, the choices in systemic therapies for moderate-to-severe plaque psoriasis have evolved with biologic immunotherapies being the main focus.

Areas covered

In this review, we describe the IL-23/Th17 axis and IL-23 inhibitors as targets for a growing family of biologics. This family includes the FDA-approved medications ustekinumab, guselkumab, tildrakizumab, and risankizumab. We will review the safety and efficacy of these medications throughout various Phase 1,2, and 3, trials for moderate-to-severe psoriasis. A literature search of PubMed was utilized for the following terms: ‘psoriasis and IL-23,’ ‘ustekinumab,’ ‘guselkumab,’ ‘tildrakizumab,’ and ‘risankizumab.’ We also searched for clinical trials involving IL-23 inhibitors registered at ClinicalTrials.gov.

Expert opinion

Anti-IL 23 therapy, especially anti-p19 monoclonal antibodies, should be considered first-line therapy for moderate-to-severe plaque psoriasis due to their efficacy and relative safety. More research is required to expand the scope of anti-p19 therapy to pediatric populations and additional indications such as psoriatic arthritis.

KEYWORDS:

• Biologics
• IL-23 inhibitors
• plaque psoriasis
• ustekinumab
• guselkumab
• tildrakizumab
• risankizumab

View correction statement:

Correction

Article highlights

• Psoriasis is a multifactorial disease involving mechanisms of the innate and adaptive immune system.

• The Th17/IL-23 axis is a prominent target for many biologics approved for moderate-to-severe plaque psoriasis.

• Several monoclonal antibodies have been approved by the FDA targeting the p19 or p40 subunits of IL-23, including ustekinumab, guselkumab, tildrakizumab, and risankizumab.

• Multiple Phase 3 trials have been performed for these medications that demonstrate safety and efficacy within this class of drugs.

This box summarizes key points contained in the article.

Declaration of interest

KB Gordon has received honoraria for consulting and/or received research support from the following companies: AbbVie, Almirall, Amgen, Arcutis Biotherapeutics, Arena Pharmaceuticals, AstraZeneca, Bristol Myers Squibb, Dermavant Sciences, Dermira, Galderma, Incyte, Janssen, Kyowa Hakko Kirin, LEO Pharma, Lilly, Novartis, Ortho Dermatologics, Pfizer, Sanofi Genzyme, Sun Pharma, and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer of this manuscript has disclosed that they are consultants and/or have participated in phase 3 clinical trials for all the drugs discussed in this manuscript. They own no drug stocks. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

A Vu, C Ulschmid, and KB Gordon have all contributed toward the conceptualization, writing, and editing of this manuscript.

Additional information

Funding

This paper was not funded.