Expert dermatologists review the efficacy of IL-23 inhibitors for plaque psoriasis in the real world, highlighting the opportunity to individualize treatment.
Bruce Strober, MD, PhD, FAAD: What have we learned about the efficacy of IL-23 inhibitors over the 5 to 7 years we’ve had them on the market?
Benjamin Lockshin, MD, FAAD: As you mentioned earlier, we’re able to achieve higher levels of skin clearance without sacrificing safety. [Findings from] multiple studies have shown that we are able to achieve either PASI [psoriasis area and severity index] 90 or PASI 100 scores and not only achieve them at the primary end point but see a durable response over the long term. We have greater effects in terms of managing these patients with chronic disease with a [long-term] medication…that we know will last for years to come. In addition, having newer-generation biologics has not only expanded my utilization of these and [consideration of] them [as] first-line therapy; it’s the feeling that I can use this medication for patients with a [smaller] body surface area. As we mentioned earlier, in terms of how we determine severity of disease, the International Psoriasis Council, which I know you’re a part of, [hits on] the utilization of these medications appropriately, which is special sites, impact on life, not using, [and] not tolerating topical medications. I think those are the justifications for using these medications, because [in] most of the clinical trials that we’ve done, those patients are slam dunks [for] systemic therapies, and [the trials] don’t include thoselow [to] moderate [drugs] , which many of us are using in our daily practice.
Bruce Strober, MD, PhD, FAAD: Jennifer, [for] IL-23 inhibition, what I have learned over the years is a forgiving approach. In other words, you can get away with long intervals between doses and you can even have patients miss doses or take a dose late. What are your thoughts about that feature of IL-23 inhibition when you speak to patients and when you approach patients with moderate to severe psoriasis?
Jennifer Soung, MD: It’s given a lot of us a lot of different tools to individualize therapy. In the end, we study a drug in a certain way because we want to understand its optimal use. But when we think of real-world use, patients are going to take [the] drug when they want to, right? So some of our patients may test intervals or spread out their injections and inject less frequently. And that makes sense because everyone metabolizes medicine a little differently. But it speaks to the fact that these medicines are highly effective that patients almost forget about their skin condition, and so it makes sense. Maybe [they] can go longer between intervals and still enjoy the clear skin that they have as well as the safety of these IL-23s.
Bruce Strober, MD, PhD, FAAD: And what we’re learning is there are these patients we label super responders who rapidly clear on IL-23 inhibitors and then stay clear over multiple months. And then those patients are defined as very tolerant of infrequent dosing. And the future rests in better identifying the patients who are super responders who might get tailored low-frequency injections. So there’s still a frontier on therapy left to be conquered so that patients are not on a one-size-fits-all approach to any mechanism of action we employ.
Transcript is AI generated and edited for clarity and readability.