Song Highlights Evolving Role of IL-23 Inhibitors in Psoriasis Care

At the 2025 Fall Clinical Dermatology Conference, E. James Song, MD, chief medical officer and director of clinical research at Frontier Dermatology, discussed new and emerging perspectives on the use of IL-23 inhibitors in the management of psoriatic disease. His presentation highlighted both evolving patient selection criteria and the expanding therapeutic potential of this biologic class.

Song emphasized that clinicians are increasingly considering systemic therapies in patients who might not have traditionally met the criteria for such treatment. “We’re now using systemic therapies in patients where maybe historically we wouldn’t have considered them to be an appropriate candidate for systemic therapy,” he explained. This shift reflects a growing understanding that disease burden is not fully captured by body surface area (BSA) alone. Patients with limited BSA involvement but high-impact areas, such as the scalp, hands, feet, or genitals, often experience significant impairment that justifies systemic intervention.

Under the guidance of Bruce Strober, MD, PhD, FAAD, and the International Psoriasis Council (IPC), a new framework has been proposed to simplify disease categorization. Song described this as a move away from the traditional “mild, moderate, and severe” system toward a more practical approach: “The IPC recommended that we re-categorize disease severity… and just simply put patients into 2 different buckets: are you a topical patient or a systemic patient?” According to this model, a patient qualifies for systemic therapy if they meet any 1 of 3 criteria: more than 10% BSA involvement, disease affecting a high-impact area, or failure of topical therapy.

Song also highlighted the continued maturation of IL-23 inhibitors, including guselkumab, risankizumab, and tildrakizumab, which have demonstrated durable efficacy, favorable safety profiles, and potential long-term disease modification. He noted that the ongoing expansion of real-world data continues to reinforce the value of these therapies not only for plaque psoriasis but across the broader spectrum of psoriatic disease.^1-2

Overall, Song’s insights reflect a field in transition, where precision in patient selection and individualized care are becoming central to treatment decisions. As understanding of IL-23 biology deepens, clinicians are better equipped to align therapeutic choice with the nuanced clinical realities of psoriasis.

References

1. Rahman SM, Ahmed F, Haque A. Role of IL-23 inhibitors including risankizumab and guselkumab in the treatment of pityriasis rubra pilaris. Arch Dermatol Res. 2024;316(6):334. Published 2024 Jun 6. doi:10.1007/s00403-024-03137-3
2. Hren MG, Miriyala S, Khattri S. The utility of interleukin-23 intraclass switching in the treatment of plaque psoriasis: a retrospective review of 43 cases. Clin Exp Dermatol. 2024;50(1):137-140. doi:10.1093/ced/llae305