IL-23 Inhibition: From Pathophysiological Jungle to Clinical Clearance

Abstract

The symposium “IL-23 Inhibition: From Pathophysiological Jungle to Clinical Clearance” took place during the 2019 annual European Academy of Dermatology and Venereology (EADV) congress in Madrid, Spain. The presentations gave an overview of how to navigate the complexities of the psoriasis treatment landscape, including updates on the newest developments in psoriasis, from pathophysiological considerations to clinical relevance, with a focus on how insights from recent trials can be applied in daily clinical practice. Prof Reich discussed the pathophysiology of psoriasis and the scientific rationale for using different classes of biologics. It is likely that IL-17 and IL-23 have differential roles in psoriasis and psoriatic arthritis (PsA) disease domains, and these different mechanistic roles translate into differences in clinical behaviour of respective inhibitors. Analyses of clinical trial data, as presented by Prof Warren, show that treatment with IL-23 inhibitors results in high levels of efficacy that can be maintained for up to 3 years, with extended maintenance of 90% reduction in the Psoriasis Area and Severity Index (PASI) 90 responses after treatment withdrawal. Furthermore, the majority of patients report improvements in quality of life during treatment, with improved Dermatology Life Quality Index (DLQI) scores after 1 year of treatment. IL-23 inhibitors are a safe treatment option for patients with psoriasis, as evidenced by data produced by long-term extension and randomised clinical trials. Prof Kirby shared his experiences managing patients with specific clinical challenges and comorbidities, such as PsA, obesity, cardiovascular diseases, psychological disorders, and inflammatory bowel disease (IBD). Current evidence indicates that IL-23 may be an attractive treatment target for disease and comorbidity management. A multidisciplinary approach to the management of psoriasis and its associated comorbidities is therefore recommended.