Practice-Changing Perspectives on IL-23 Inhibition and Early Intervention in Psoriatic Disease

Saakshi Khattri, MD, outlines her key practice-changing takeaways for dermatologists and rheumatologists.

In the final segment, Saakshi Khattri, MD, synthesizes practice-changing messages from the risankizumab data across psoriasis and PsA for both dermatologists and rheumatologists.

For dermatologists, she underscores that while no prospective prevention trials have definitively established that any biologic class prevents PsA, retrospective claims and database analyses indicate a class-level signal that IL-23 inhibition may be associated with reduced PsA incidence in patients with psoriasis. On this basis, she considers IL-23 inhibitors, including risankizumab, to be strong systemic options for psoriasis patients, particularly those at elevated risk for joint disease.

From the rheumatology perspective, Khattri points to the 5-year data demonstrating radiographic non-progression and sustained clinical efficacy with risankizumab in PsA as especially important. She notes that the combination of structural protection, durable clinical response, and the agent’s relatively infrequent dosing schedule aligns with key concerns voiced by patients, who often ask about both how long a drug will work and how many injections per year are required. The absence of newly emerging long-term safety concerns further supports its role as a long-term treatment option in appropriate candidates.

Khattri also introduces the concept of a “window of opportunity” in psoriatic disease, drawing an analogy to established paradigms in rheumatoid arthritis. She suggests that earlier initiation of systemic therapy—potentially with IL-23 inhibition, given current data—may offer a chance to influence the trajectory of disease and possibly reduce the likelihood of progression from psoriasis to PsA, even though this remains a hypothesis rather than a proven principle. She concludes by reiterating that, taken together, the data on potential PsA risk reduction, durable radiographic outcomes, and stable long-term safety make IL-23 inhibition, and risankizumab specifically, a valuable component of the therapeutic armamentarium for psoriatic disease.