Dr. April Armstrong discusses key benefits and newer developments in IL-17 and IL-23 inhibitors for the treatment of moderate to severe plaque psoriasis.
April Armstrong, MD, is Professor of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, California
“At the Winter Clinical, we oftentimes do a deep dive into the different biologics. For the past few years, we have focused on IL-17 inhibitors versus IL- 23 inhibitors in the treatment of psoriasis,” said April Armstrong, MD, who co-presented “What’s New and Hot in Biologics” at the 2022 Winter Clinical Dermatology Conference.
“This year at this winter clinical, I was fortunate to be discussing this topic with Dr. Alice Gottlieb. Each of us talked about some of the patient populations that that could especially benefit from IL- 17 inhibitors or IL- 23 inhibitors.”
IL-17 Inhibitors
Time can be a factor when treating moderate to severe plaque psoriasis. One of Dr. Gottlieb’s takeaways was that IL-17 inhibitors have a quick onset of action, said Dr. Armstrong. The IL-17 inhibitors that were specifically discussed included secukinumab (Cosentyx, Novartis), ixekizumab (Taltz, Eli Lilly), brodalumab (Bausch Health).
“One key characteristic that we have observed with IL-17 inhibitors as a class is that they have a fast onset of action. This was observed both clinically as well as in the clinical trials. In addition to that, IL-17 inhibitors are effective in terms of treating both peripheral arthritis as well as axial arthritis.”
Dr. Gottlieb presented a variety of patient cases, one of which was a patient with plaque psoriasis who was getting married, said Dr. Armstrong.
“The person was treated with an IL- 17 inhibitor and was able to get rapid clearance and was able to get married without worrying about the psoriasis.”
Many clinical trials have also shown efficacy for the treatment of psoriatic arthritis, said Dr. Armstrong.
“In fact, there are a number of head-to-head studies comparing IL-17 inhibitors vs [Tumor necrosis factor (TNF)] inhibitors in the treatment of psoriatic arthritis, and [they] have shown that IL-17 inhibitors are at least as good as TNF inhibitors in terms of treating both the peripheral as well as axial components of psoriatic arthritis.”
Bimekizumab (Bimzelx, UCB) is an emerging, promising IL-17 inhibitor with a unique mechanism of action that inhibits both IL-17A as well as IL-17F and may, as a result, offer superior efficacy.
“Bimekizumab has quite fast onset of action and has robust efficacy in numbers that we haven’t really observed previously. This will be another great option for patients with moderate to severe plaque psoriasis.”
Currently, adalimumab (Humira, Abbvie) is the only biologic FDA approved to treat hidradenitis suppurativa (HS), but secukinumab and bimekizumab are also under investigation, said Dr. Armstrong.
“[For secukinumab,] they have completed the pivotal studies [and] top line results have shown that secukinumab compared to placebo was superior in treating HS, and we look forward to seeing more details hopefully of these studies are coming up in the coming months.”
IL-23 Inhibitors
According to Dr. Armstrong, the IL-23 class of inhibitors changed the landscape of treatment for psoriasis patients. Guselkumab (Tremfya, Janssen) was the first IL- 23 that was FDA approved for moderate to severe plaque psoriasis
“We now have 5-year data on guselkumab and what it shows is that this medication has a long, durable action in patients with moderate to severe plaque psoriasis. So, if you have a patient on one of the IL-23 inhibitors, and if they had responded in the first place, the likelihood of maintaining that response is quite high.”
“We see this durability of response also with other IL- 23 inhibitors, for example, such as risankizumab (Skyrizi, Abbvie) as well as tildrakizumab (Ilumya, Merck).”
Notably, guselkumab is also approved to treat palmoplantar pustulosis in Japan, said Dr. Armstrong.
“…palmoplantar pustulosis is a very difficult-to-treat condition and having a biologic that is more extensively studied for that particular subtype of psoriasis is very important. Showing superior efficacy compared to placebo and [being] able to bring relief to our patients for palmoplantar pustulosis is also very important.”
In other news, risankizumab was given FDA approval for psoriatic arthritis (PSA) following the Winter Clinical meeting this year, said Dr. Armstrong.
“A third of our patients with psoriasis, ultimately, may develop psoriatic arthritis if untreated. …we now have three agents that are approved not only just for psoriasis, but also for PSA.”
These include ustekinumab (Stelara, Janssen), an older agent that blocks both IL-23 and IL-12, guselkumab, and risankizumab.
“This is really important because we typically initially think about IL-23 blockers as a class as focusing solely on the skin…. But we really have this mounting data of their efficacy in PSA as well.”
One key advantage of IL-23 inhibitors is the convenient dosing regimen, said Dr. Armstrong.
“Either every eight weeks or every 12 weeks—one or two shots either every two months or every three months—I think [for] a lot of our patients, for example, who may have busy schedules or who may need to travel…. This can be a class of agents that can be quite convenient to that particular lifestyle.”