Abstract
IL-23 inhibitors are a newer class of biologics that specifically target the p19 subunit of IL-23, a cytokine believed to play an important role in the pathogenesis of psoriasis. Currently, three IL-23 inhibitors have been developed for psoriasis: guselkumab, tildrakizumab, and risankizumab. Guselkumab was US Food and Drug Administration (FDA) approved in July 2017 following the VOYAGE 1, VOYAGE 2, and NAVIGATE trials demonstrating favorable clinical efficacy and safety profile, and is being studied for use in psoriatic arthritis and Crohn disease. Tildrakizumab was FDA approved in March 2018 and is also being investigated for use in psoriatic arthritis and ankylosing spondylitis. Risankizumab, though not yet FDA approved, has shown promise in psoriasis through phase III trials UltiMMa-1, UltiMMa-2, IMMvent, and IMMhance. Thus far, no specific safety signals or significant antibody formation have been associated with use of IL-23 inhibitors, though further studies are needed to evaluate long-term safety. In addition, two other IL-23 inhibitors, mirizkiumab and brazikizumab, are being studied for diseases including psoriasis, Crohn disease, and ulcerative colitis.
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