Understanding the Psoriasis Treatment Landscape and Available IL-23 Inhibitors

In this episode, "Understanding the Psoriasis Treatment Landscape and Available IL-23 Inhibitors," the expert dermatologists explore the current state of treatment options for moderate to severe plaque psoriasis and the practical considerations that guide therapy selection.

The panel opens by surveying the available treatment landscape, noting that while both oral and injectable biologic options exist, the newer IL-17 and IL-23 inhibitors lead in efficacy, achieving high PASI responder rates in a relatively short timeframe. Oral therapies are acknowledged as an option for milder disease or for patients with a strong preference for a pill, but the panel notes that infrequent injection schedules of every 8 to 12 weeks are no longer a significant barrier for most patients, in part due to the widespread normalization of injectable medications for other conditions such as weight loss. The limitations of oral agents, including broader immunosuppression and less favorable efficacy, safety, and tolerability profiles compared to biologics, are also discussed.

The panel then provides a focused overview of the three FDA approved IL-23 inhibitors currently available. Risankizumab and guselkumab are noted as strong performers in achieving high therapeutic outcomes with similar onset of action and meaningful data in psoriatic arthritis as well. Tildrakizumab is characterized as somewhat slower in onset but capable of maintaining high levels of efficacy over time, with the added advantage of eligibility for Medicare benefit, making it a useful option for older patient populations.

The panel concludes that while no single therapy controls every patient, IL-23 inhibitors collectively handle a significant portion of the treatment burden in clinical practice, with the majority of patients able to achieve complete or near complete clearance with these agents.

The next episode in this series, "Evaluating Treatment Selection in Psoriasis," features the panelists advancing their conversation on psoriasis and focusing on the practical framework for choosing between TNF, IL-17, and IL-23 inhibitors based on patient specific factors, as well as the clinical and practical implications of biosimilar use and formulary driven treatment decisions.