What clinical factors guide your decision to initiate an IL-23 or IL-17 inhibitor in patients with psoriatic disease?

The IL-23/IL-17 axis is central to the pathogenesis of psoriatic disease, and therapeutic targeting of these pathways has led to a paradigm shift in treatment approaches.¹ However, it is not always clear whether an IL-23 or an IL-17 inhibitor would be more appropriate.

The PsOPsA Hub spoke with Peter Nash, Griffith University, Queensland, AU. We asked, What clinical factors guide your decision to initiate an IL-23 or IL-17 inhibitor in patients with psoriatic disease?

Key learnings

• Both IL-17 and IL-23 inhibitors are well tolerated, supporting their use as first-line options in the treatment of psoriatic disease.
• IL-17 inhibitors offer broad domain coverage, including skin, nails, axial, and peripheral joints.
  • They are associated with a low risk of Candida infections, which are easily manageable, and a rare risk of inflammatory bowel disease (IBD) worsening (approximately 1/1,000 in psoriatic disease and 5–7/1,000 in axial spondyloarthropathies).
• IL-23 inhibitors are highly effective in skin, nails, and peripheral joint involvement; however, there is currently a lack of robust evidence to support their use in axial disease involvement.
  • Unlike IL-17 inhibitors, they are associated with minimal IBD-related risk and therefore may offer therapeutic benefit in patients with coexisting IBD.
• Treatment selection should be guided by the dominant disease domain, with both IL-17 and IL-23 inhibitors offering strong efficacy and favorable safety profiles, each with minor, class-specific limitations.

This educational resource is independently supported by UCB. All content was developed by SES in collaboration with an expert steering committee. Funders were allowed no influence on the content of this resource.