The efficacy and safety of IL-17 and IL-23 inhibitors in psoriatic arthritis across multiple disease domains
DOI:
https://doi.org/10.25251/zsav4a48Keywords:
psoriatic arthritis, psoriasis, PsA, biologic, IL-17, IL-23, efficacy, safety, axial spondyloarthritisAbstract
disease affecting peripheral joints, entheses, skin, and nails. Despite multiple available biologic therapies, unmet needs persist, particularly in patients with multisystem involvement or prior biologic failure. Interleukin-17 (IL-17) and interleukin-23 (IL-23) pathway inhibitors are widely used in PsA; however, important differences exist in their clinical efficacy across disease domains.
Methods: A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar to identify randomized controlled trials, long-term extension studies, mechanistic studies, and meta-analyses evaluating IL-17 and IL-23 inhibitors in PsA and related spondyloarthritides. A multidisciplinary panel of expert dermatologists and rheumatologists convened for a structured roundtable discussion. A modified Delphi process was used to develop and approve consensus statements. Strength of Recommendation Taxonomy (SORT) criteria were applied to each statement.
Results: Eight consensus statements were unanimously adopted. These statements address radiographic progression, axial disease, mechanistic considerations of IL-17A and IL-17F inhibition, comparative efficacy of bimekizumab, treatment sequencing, and safety considerations including candidiasis, hepatic effects, and psychiatric outcomes.
Conclusion: Based on the totality of available evidence, IL-17 inhibitors play an important role in the management of PsA across multiple disease domains. Differences between IL-17 and IL-23 pathway inhibition have important implications for treatment selection, particularly in patients with axial disease, significant skin involvement, or prior biologic failure.
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Copyright (c) 2026 Danny Zakria, Milaan Shah, Angela Rosenberg, Joshua Burshtein, Lauren DeBusk, David A. Altman, April W. Armstrong, Alice B. Gottlieb, George Han, Saakshi Khattri, Sheila Shaigany, Jeffrey M. Weinberg, Mark G. Lebwohl (Author)
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