IL-23 inhibitors may reduce psoriatic arthritis risk among patients with psoriasis
Key takeaways:
- Approximately 60% to 85% of patients who develop psoriatic arthritis will have first developed psoriasis.
- Blocking IL-23 may block other proinflammatory cytokines implicated in psoriasis.
ORLANDO — Interleukin-23 inhibitors may be able to reduce the risk of developing psoriatic arthritis among patients with psoriasis, according to a speaker at the American Academy of Dermatology Annual Meeting.
According to Anthony P. Fernandez, MD, PhD, director of medical dermatology, WD Steck chair of clinical dermatology, comedical director of CME at the Cleveland Clinic, and a member of the Healio Dermatology Peer Perspective Board, between 60% and 85% of patients who develop psoriatic arthritis (PsA) will have first developed cutaneous psoriasis. Further, the time between the onset of skin disease and the onset of joint disease is between 3 and 12 years.
“For the majority of our patients with psoriasis, we have this window of opportunity during which, if we have adequate medications, we can prescribe them to the patients when they get psoriasis and potentially inhibit the future development of PsA,” Fernandez said during his presentation. “So, of course, a major question is, do any of the biologic medications that we have available to us now allow us to do that?”
Studies have shown mixed results on this front, according to Fernandez, with some presenting evidence in favor of biologics’ preventive properties for PsA and others not. However, all of these studies predated one specific type of biologic — the IL-23 inhibitor.
“This is important because there are a lot of clinicians and researchers who believe that IL-23 inhibitors are unique compared to other classes of biologics,” he said, stating that IL-23 is considered the “master cytokine” in the pathogenesis of psoriasis.
IL-23 plays a large role in the terminal differentiation and survival of T-helper 17 cells, Fernandez explained, meaning IL-23 inhibition could reduce the number of T-helper 17 pathogenic cells in the body.
IL-23 is also responsible for the production of other proinflammatory cytokines that are implicated in the pathogenesis of psoriasis, such as IL-17A and IL-22. Blocking IL-23 may block these other cytokines as well.
This has been supported in other studies with one, published in The Lancet Rheumatology in 2023, showing that patients with psoriasis who were prescribed either IL-12/23 or IL-23 inhibitors had a significantly decreased risk of developing inflammatory arthritis compared with those prescribed tumor necrosis factor inhibitors. This same reduction in risk was not seen among those treated with IL-17 inhibitors.
“After this study, there have been numerous others that have reproducibly shown that it seems IL-23 inhibitors may be associated with a lower future risk of developing PsA when given to patients who have psoriasis,” Fernandez said. “If we’re going to get good data to say anything definitive about this, it’s going to have to be through a prospective, well-designed study that follows patients out long enough... and that study may be going on right now... so stay tuned.”