Elevating Psoriasis Care: The Role of IL-17 Inhibition in Advancing On-Treatment Remission - Episode 7
Exploring the IL-17 vs IL-23 Debate in Psoriasis
"Exploring the IL-17 vs IL-23 Debate in Psoriasis " takes up a deliberately provocative question from the moderator.
"Exploring the IL-17 vs IL-23 Debate in Psoriasis " takes up a deliberately provocative question from the moderator.
Dr. Wright says the answer is complicated. For axial psoriatic arthritis she reaches for an IL-17, a TNF, or a JAK, because the supporting data are stronger there. Peripheral, hands-and-feet disease is less complicated to treat. She insists on paying attention to the axial skeleton and distinguishing degenerative from inflammatory disease, since the nuances differ.
Dr. Wright returns to a measurement problem. Against adalimumab the joints have consistently been non-inferior rather than clearly better. She explains that ACR50 means at least 50% improvement, so a patient could be at 65% or 69% and still be counted the same. That wide span makes nuanced differences between drugs hard to detect.
Dr. Han describes a strong preference for IL-23s in many dermatology offices. Clinicians appreciate their simplicity when there are no comorbidities like inflammatory bowel disease to weigh, their less frequent dosing, and newer oral IL-23 peptides that need no lab monitoring or TB screening. He addresses claims that IL-23s are more durable or better for heavier patients with a grain of salt, noting every biologic loses efficacy at the highest weight ranges.
Dr. Han cautions against holding beliefs too strongly against newer data. He recounts a surprising finding that an IL-23 inhibitor failed in phase 2 trials for axial disease, which was counterintuitive given the shared cytokines. He contrasts that with guselkumab's modestly positive axial signal on patient-reported outcomes. His closing point is that clinicians are lucky to have strong options across the board and can now tailor first-line choices to what matters most to each patient, from onset speed to joint involvement.
The next episode in this series, "BE BOLD Head-to-Head: IL-17 vs IL-23 for Psoriasis and PsA," features Dr. Wright walking through the BE BOLD head-to-head trial in detail and what its results mean.
