A peek at the pipeline

There is tremendous excitement surrounding IL-23 inhibitors for the treatment of psoriasis. Three are currently in the pipeline.

One is guselkumab, which has completed phase III trials and data has been submitted to the FDA for approval. The second is risankizumab. There was a study published April 20, 2017 in the New England Journal of Medicine showing risankizumab had a superior clinical response in the treatment of moderate-to-severe plaque psoriasis, compared to ustekinumab. Tildrakizumab is a third.1

“These are all biologic injectable medicines that bind the p19 subunit of IL-23. In clinical trials, they have gone head-to-head with medications like adalimumab and ustekinumab and have shown significantly superior results,” Dr. Fernandez says. “IL-23 is kind of a master cytokine in psoriasis, we think. It’s required not only for the differentiation but for the survival of Th17 cells, which we think are key pathogenic cells in psoriasis.”

Blocking IL-23 may result in responses and better dosing schedules over time, he says.

“There’s some pre-clinical data to suggest that blocking IL-23 may even be associated with decreased risk of infection burden for patients with psoriasis and less of an impairment on patients’ immune systems in terms of its ability to attack abnormal cells that may be cancerous or precancerous,” Dr. Fernandez says.

Reference:

Papp KA, Blauvelt A, Bukhalo M, et al. Risankizumab versus Ustekinumab for Moderate-to-Severe Plaque Psoriasis. N Engl J Med. 2017;376(16):1551-1560.