Use of IL-23 Inhibitors for the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review
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REVIEW ARTICLE
Use of IL‑23 Inhibitors for the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review Kevin Yang1 · Allen S. W. Oak1 · Boni E. Elewski1
© Springer Nature Switzerland AG 2020
Abstract Psoriasis is a common inflammatory skin disease with multiple comorbidities, including psoriatic arthritis and coronary artery disease, that can severely impact an individual’s quality of life and daily functioning. In recent years, enhanced understanding of the pathogenesis of psoriasis, especially the role of T helper 17 cells, has resulted in the development of new classes of biologic drugs targeting modulators along its disease pathway. Among these, inhibitors of interleukin-23 (e.g., ustekinumab, guselkumab, tildrakizumab, and risankizumab) have emerged as safe and effective options for the treatment of moderate-tosevere plaque psoriasis; ustekinumab and guselkumab have additionally been approved to treat psoriatic arthritis. Selective interleukin-23 inhibitors require less frequent dosing than interleukin-17 inhibitors and may possess a more favorable risk profile without an increased risk of candidiasis or inflammatory bowel disease. Overall, these highly effective medications are contributing to a rising standard for psoriasis outcomes through resolution of skin lesions and joint manifestations and improvement of patient quality of life.
Key Points Interleukin (IL)-23 plays an important role in the development of psoriasis and psoriatic arthritis. IL-23 inhibitors are effective in treating psoriasis and psoriatic arthritis. IL-23 inhibitors are safe and do not show a significantly increased risk for adverse events.
1 Introduction Psoriasis is a chronic inflammatory disease affecting over 7 million people in the USA with an estimated annual financial burden of over US$112 billion [1, 2]. Plaque psoriasis is the most common subtype and classically manifests as
* Allen S. W. Oak [email protected] 1
Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
erythematous plaques with an overlying micaceous silvery scale on the trunk and extensor surfaces of the extremities; less common subtypes include inverse, guttate, and pustular [3, 4]. Nail lesions, such as pitting and onycholysis, may also be seen. Psoriasis is also associated with multiple comorbidities, including cardiovascular disease, metabolic syndrome, psychiatric conditions, malignancy, renal disease, and hepatic disease [5]. Psoriatic arthritis (PsA) is an inflammatory arthritis that may co-occur in up to a third of patients with psoriasis [6]. Psoriatic arthritis clinically presents with dactylitis, as well as enthesitis of the plantar fascia and Achilles tendon [7]. Psoriatic arthritis usually arises approximately 10 years after the onset of psoriatic lesions. However, it may precede the skin findings in 15% of cases [7]. Psoriatic arthritis may be difficult to distinguish from other inflammatory arthritides, but the morbidity of the disease warrants a low threshold for initiation of
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