Patients with psoriatic arthritis (PsA) often live with debilitating chronic symptoms, ranging from joint and bone pain to skin lesions. Fortunately, physicians have plenty of treatment options for patients with PsA, including a laundry list of effective biologics. 

More so, research published in The Lancet found that IL-23 inhibitors resulted in fewer serious adverse events, including infections, when compared to TNF inhibitors.

Jairath V, Felquer MLA, Cho RJ. IL-23 inhibition for chronic inflammatory disease. The Lancet. 2024;404(10463):1679–1692.

Additionally, a recent study showed that psoriasis patients treated with IL-23s were at lower risk of developing PsA than those receiving  IL-17 and TNF inhibitors.

Strober B, Soliman AM, Li C, et al. Risk of developing inflammatory arthritis with psoriasis initiating treatment with biologics: A population-based analysis. Journal of the American Academy of Dermatology. 2024;91(6):1143–1149.

Benefits of treating with IL-23s, per the experts

Stella Bard, MD, a rheumatologist at Arthritis & Rheumatology Care PC in Brooklyn, says that, for starters, IL-23s carry a lower risk of infection than first-generation biologics. But they’re also more effective: “IL-23s will be most useful in patients who have a large amount of psoriatic skin involvement. They are much better at clearing the skin vs TNF inhibitors,” she says. “They should also work longer term, because they have less of a risk of inducing neutralising antibodies, which are produced by the body, surround the drug, and render it inactive.”

Dr. Bard says patients also prefer the less-frequent administration schedule of IL-23s. For example, risankizumab (Skyrizi) requires one injection four times per year after just two starter doses, vs adalimumab (Humira), which generally requires an injection every other week.

SKYRIZI injection support. Skyrizi Complete.

HUMIRA for Psoriatic Arthritis (PsA). HUMIRA.

This convenience, Dr. Bard says, “allows for better patient adherence than drugs that require more frequent administration. She adds that IL-23s can also be a “great alternative for people who cannot take a TNF inhibitor."

Positive impacts on IBD symptoms

According to 2024 research published in Expert Opinion on Biological Therapy, the “pivotal role of [IL-23] in the pathogenesis of PsA has become increasingly evident,” making it a topline therapy for PsA.

Su QY, Gao HY, Duan YR, et al. The immunologic role of IL-23 in psoriatic arthritis: a potential therapeutic target. Expert Opinion on Biological Therapy. 2024;24(10):1119–1132.  

That said, the authors note that more information is needed on the long-term effects of drugs within the IL-23 family and that drug targets within the IL-23/IL-23 R axis warrant further exploration.