Anti-IL-23 agents offer long remission rates for psoriasis
MIAMI BEACH, Fla. — Anti-interleukin-23 agents tildrakizumab, guselkumab, risankizumab and mirikizumab are effective in treating patients with psoriasis, with one of the longest remission durations of any drug currently in use, according to a presenter at South Beach Symposium.
“The key molecule in treating psoriasis is blocking IL-17. What IL-23 does is it downregulates the TH-17 cells production of IL-17,” Mark Lebwohl, MD, said during the presentation. “When you block IL-23, it downregulates it. When you stimulate that cell with IL-23 [it] upregulates it, so you stop making IL-17. When that occurs, the cell hibernates and takes months to reconstitute, which is why we’re seeing long remissions from these drugs.”
Original trial results for tildrakizumab showed a 66% response rate at week 12 and an 86% response rate at week 28. Although response rates are slower in effect, following patients over a 5-year period showed they continued to respond to the drug, with 51% relapsing at week 64, 48 weeks after injection.
Trial results for the other drugs follow suit, with slower response times accompanied by long-term positive results: risankizumab with 68% of patients having a Psoriasis Area and Severity Index score of 90 at week 16 and peaking at 81.6% at week 22; guselkumab with 91% of patients having a PASI score of 75 at week 16, which was well maintained through week 48; and mirikizumab with phase 1 data yielding a mean PASI score of 100.
According to Lebwohl, although efficacy translates well across different weight classes, with 97% improvement in patients with lower and heavier body weight, effectiveness decreases in patients with obesity by about 9%.
Long remission rates and infrequent long-term dosing make these drugs ideal for many patients, Lebwohl said.
“Patients who travel a lot don’t want to be carrying syringes. ... If somebody needs to travel with their syringes, tildrakizumab can be kept out of the refrigerator for 30 days and is particularly good for patients who are unable to self-inject,” he said. – by Kate Burba
Lebwohl M. Tips in the use of anti-IL-23 drugs. Presented at: South Beach Symposium; Feb. 6-9, 2020; Miami Beach, Florida.
Disclosure: Lebwohl reports no relevant disclosures.