Targeting Structural Damage in Psoriatic Arthritis: The Impact of Early Recognition and Timely Intervention - Episode 10
Guselkumab and Structural Damage Inhibition in Psoriatic Arthritis: Insights from the APEX Trial
Experts discuss recent clinical evidence confirming that IL-23 inhibitors effectively inhibit structural damage in psoriatic arthritis—particularly highlighted by the APEX trial’s findings in bio-naive patients—reinforcing their emerging role as a safe, convenient, and increasingly preferred first-line treatment for both joint and skin manifestations.
Recent advances in clinical research have provided critical clarity around the ability of IL-23 inhibitors to inhibit structural damage in psoriatic arthritis, a key concern for clinicians considering long-term outcomes. Early trials such as DISCOVER-2 initially suggested promise, but the approved every-8-week dose of one agent narrowly missed statistical significance in halting radiographic progression. This uncertainty led to the development of a larger, more targeted study—the APEX trial—which focused on bio-naive patients with evidence of existing joint damage. Results showed that both dosing regimens significantly inhibited structural progression, providing much-needed reassurance for clinicians.
For years, many prescribers hesitated to consider IL-23 inhibitors first line for joint disease, despite their clear effectiveness in skin clearance. With the APEX data now confirming structural protection, clinicians can confidently consider these agents even for patients with more aggressive or erosive disease. This is particularly impactful given that IL-23 inhibitors offer notable advantages in safety and dosing convenience. The ability to protect joints while minimizing serious adverse effect concerns and maintaining a low-frequency dosing schedule has the potential to shift prescribing patterns, especially for patients prioritizing long-term joint function and quality of life.
The favorable safety profile of IL-23 inhibitors also streamlines patient counseling. Discussions can often be shorter and more reassuring, as concerns commonly associated with other biologic classes—such as TB reactivation, depression, or cancer risk—are not prominent in the IL-23 data. Although some safety protocols such as TB testing remain in place for insurance reasons, clinical experts increasingly see these agents as both effective and low risk. As dermatologists and rheumatologists gain more confidence from robust evidence, the role of IL-23 inhibitors as a legitimate first-line option for both skin and joint involvement is expected to grow substantially.
