Expert Physician Assistant & Nurse Practitioner Insights on the Management of Plaque Psoriasis from Real-World Data - Episode 7

Safety and Efficacy of IL-23 Inhibitors for Plaque Psoriasis

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Jayme Heim, MSN, FNP-BC, and Matthew T. Reynolds, PA-C, comment on potential safety concerns and adverse events regarding the use of IL-23 inhibitors as well as the long-term safety and efficacy of these therapies in plaque psoriasis.

Jayme Heim, MSN, FNP-BC: In regard to the safety concerns, do you have any related to this particular class of drugs or adverse events?

Matthew T. Reynolds, PA-C: I think the IL-23 [interleukin-23] class is a really clean class. When I’m treating patients that I feel are a little bit sicker—they have a lot of comorbid conditions, your patients that certainly have had a history of cancer, they have a lot of other specialists that they see—I tend to lean on the IL-23 class. Again, I mentioned the most common adverse events we see with these patients are mild to moderate in their severity, but upper respiratory tract infections and nasopharyngitis are the No. 1 and No. 2. But again, these event rates are fairly low. I think for us, when we do have adverse events, if they do come about, we typically will have the patient stop their drug or hold their drug. That’s a little challenging because the dosing cycle is every 2 to every 3 months. But I typically will have the patient hold their injection for the week that they’re sick. That’s the general recommendation at this time, that if you have a patient that’s got a cold or they’ve got an infection that’s non-resolving, it is just recommended that you hold the medication until they overcome that infection. But again, with this class of drug specifically, I haven’t had many adverse events in my patients, and I have a lot of them, but thankfully this is a class that I really hang my hat on as far as overall safety as well as efficacy.

Jayme Heim, MSN, FNP-BC: Absolutely. I agree with you completely. This is really 1 of the classes of medications for psoriasis that I feel very comfortable with. When we look at overall effectiveness and safety as well as just side effects, very little. Of course, with evaluation, we would never put it on a patient who has frequent infections, but this class is a go-to class. Let’s talk about 5 years long term of efficacy and safety data that have been released regarding the use of IL-23 inhibitors in patients with moderate to severe plaque psoriasis and demonstrate a consistent and favorable safety profile. In your opinion, what is the importance of long-term data to increase the practitioner’s confidence in the utilization of a therapeutic modality?

Matthew T. Reynolds, PA-C: This is really great to have. I think we all wait for this data to come out, and a lot of us have our suspected notions of what the data’s going to look like before it comes out. If you do clinical trials and you’re watching these drugs over time, you’re involved in long-term extension studies, you already know. For us, with 5-year data, most practitioners that are not really the early adopters of drugs wait for this data to come out. Thankfully, the data show exactly what we suspected. Overall, adverse event rates go down with time. The highest incidence of adverse event rates is usually common in that first 1 to 2 years, but again, those adverse event rates being low-rate infections such as upper respiratory tract infections and nasopharyngitis, very scant amounts of injection site reactions across either the 23 class or the 17 class. It’s great to know that the first year is going to be the roughest if you have any events, but over time, your patients will continue to do well. The longer they stay, typically, the better their psoriasis does. We see this not only in their psoriasis but all their other comorbid inflammatory conditions that are associated with psoriasis. But again, I think the other thing that people always ask about with the IL-23 class is the incidence rates of metabolic syndrome in patients treated with IL-2s. Thankfully, those event rates also go down over time. I think it’s important to treat aggressively and treat early, but also to try to do everything you can to keep your patients on therapy, because you know that the longer they stay on the drug, the better they’re going to do.

Transcript edited for clarity