Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

Saakshi Khattri, MD, FACR, FAAD

The panelists review EADV 2025 data evaluating whether bimekizumab may help prevent PsA development in patients with psoriasis only. The study followed psoriasis patients prospectively and stratified risk using clinical factors and a patient questionnaire (PASE), treating scores <47 as low risk and ≥47 as high risk. Among patients with >1 risk factor treated with bimekizumab, over 96% maintained PASE scores <47 on longitudinal follow-up—used here as a patient-reported surrogate for not developing PsA symptoms (noting the limitation of no comparator arm). These findings align with real-world practice that prioritizes identifying high-risk patients and monitoring symptom trajectories over time. Overall, the experts interpret the stratified results as supportive—though preliminary—evidence that sustained IL-17A/F blockade may reduce transition to PsA in higher-risk psoriasis populations, while emphasizing the need for prospective, comparative data.

Bimekizumab in Psoriasis: EADV 2025 Insights and Approaches to Patient Monitoring

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In this episode, the panelists share clinical perspectives on positioning IL-17 inhibitors within psoriasis treatment. The experts discuss that among available biologic options, IL-17 inhibitors provide rapid and durable skin clearance, making them an important choice for patients with moderate to severe psoriasis. They highlight the significance of dual IL-17A and IL-17F inhibition, noting that it offers greater depth of response compared to targeting IL-17A alone. When selecting therapy, the panel emphasizes tailoring treatment to individual patient factors—such as nail involvement, disease burden, or potential psoriatic arthritis risk. They also consider head-to-head data showing that IL-17 inhibitors can achieve superior outcomes compared with other classes, including IL-23 inhibitors, in certain patient groups. The experts conclude that positioning IL-17 inhibitors early in the treatment algorithm may not only improve skin outcomes but also support prevention of disease progression.

Clinical Perspectives for Positioning IL-17 Inhibitors in Psoriasis Care

In this episode, the panelists focus on the IL-23 and IL-17 pathways and their influence on inflammation control and psoriatic arthritis (PsA) prevention. The experts explain that IL-23 sits at the top of the inflammatory cascade, driving Th17 cell activation and downstream cytokine release. They note that inhibiting IL-23 can lead to long-term immunologic remission and possibly modify PsA progression, given its infrequent dosing and favorable safety profile. The discussion compares IL-23 and IL-17 inhibition, highlighting that while IL-23 blockade targets disease upstream, IL-17 acts as the “enforcer” cytokine driving local joint and skin inflammation. The panelists review emerging data showing that dual inhibition of IL-17A and IL-17F, as achieved with newer biologics, may provide more robust and durable skin clearance than targeting IL-17A alone. They conclude that deeper inflammation control through these pathways could reduce PsA risk and sustain long-term disease remission.

Targeting IL-23 and IL-17 in Psoriatic Disease: Pathways to Inflammation Control and PsA Prevention

In this discussion, the panelists examine current evidence supporting early systemic treatment in psoriasis to help prevent psoriatic arthritis (PsA). The experts reference retrospective and observational studies suggesting that biologic therapies—particularly IL-17 and IL-23 inhibitors—may reduce the incidence of PsA development among patients with psoriasis. While acknowledging limitations in available data, such as the lack of prospective randomized trials, the panelists agree that existing evidence is meaningful and should inform proactive management. They stress that early initiation of systemic therapy can address the shared inflammatory pathways of skin and joint disease, potentially modifying disease progression before irreversible joint damage occurs. The experts highlight the importance of shifting from reactive to preventive care, emphasizing that treating psoriasis systemically and earlier in its course could close the current gap between achieving complete skin clearance and preventing long-term musculoskeletal complications.

Saakshi Khattri, MD, FACR, FAAD

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