Drug Survival, Effectiveness of IL-23 Inhibitors for Psoriasis, PsA

Interleukin-23 (IL-23) inhibitors have high drug survival and effectiveness when used in a real-world setting for the treatment of psoriasis and psoriatic arthritis (PsA), according to the results of a retrospective, observational study.

“To our knowledge, this is the first study to evaluate the drug survival and effectiveness of all clinically available IL-23 inhibitors on psoriasis and PsA in a real-world setting,” the authors noted.

The three IL-23 inhibitors studied here – guselkumab, tildrakizumab, and risankizumab – have all been approved for the treatment of psoriasis, with both guselkumab and risankizumab also being approved for the treatment of psoriatic arthritis.

The study population consisted of 80 adults who had been treated with guselkumab, tildrakizumab, or risankizumab from June 11, 2018 to July 14, 2021 at a single university center. A total of 19 patients discontinued treatment during the study period. The mean treatment duration was 61.4 weeks. Previous use of more than one biologic was observed in 95% of patients (n = 76).

The primary outcomes included drug survival, reasons for discontinuation, and clinical effectiveness on psoriasis or PsA. Drug survival was defined as the time from initiation to discontinuation due to adverse effects, lack or loss of effect on symptoms, or discontinuation due to other reasons.

The results indicated that the 1-year drug survival was 80.96%. Further, 64.3% of patients achieved a Psoriasis Area and Severity Index (PASI) score of 2 or less at weeks 12-17 and 61.3% achieved this score at weeks 40-60. No statistically significant difference for achieving a PASI score of two or less was observed between the medications.

Of the total patients, 27.5% (n = 22) had PsA and among these patients, 40.9% achieved complete remission and 36.4% achieved partial remission.

Limitations to the study include the use of qualitative measures and broad time periods (weeks 12-17 and weeks 40-60) in which the researchers measured effectiveness.

“IL-23 inhibitors are well-tolerated by and effective for patients with difficult-to-treat psoriatic disease,” the authors concluded. “The study has confirmed the high overall drug survival reported by other studies.”

Reference:

Elgaard CDB, Iversen L, Hjuler KF. Guselkumab, tildrakizumab, and risankisumab in a real-world setting: drug survival and effectiveness in the treatment of psoriasis and psoriatic arthritis. J Dermatolog Treat. 2023;34(1):2133531. doi:10.1080/09546634.2022.2133531.