Targeting the IL-23/IL-17 Pathway in Psoriasis: the Search for the Good, the Bad and the Ugly

Area of Science:

• Immunodermatology
• Molecular Medicine
• Pharmacology

Background:

• Psoriasis treatments have evolved with novel therapies targeting the interleukin (IL)-23/IL-17 pathway.
• This targeted approach aims for greater disease specificity and potentially mitigates long-term adverse events associated with broader immunosuppression.
• Significant improvements in Psoriasis Area and Severity Index (PASI) scores have been achieved, redefining treatment objectives.

Purpose of the Study:

• To review current knowledge on inhibitors targeting the IL-23/IL-17 pathway for psoriasis.
• To discuss the advantages and disadvantages of different molecular targets within this pathway.
• To explore the role of IL-17 in other diseases and comorbidities.

Main Methods:

• Literature review of scientific publications on IL-23 and IL-17 inhibitors.
• Categorization of therapeutic agents based on their specific molecular targets (e.g., IL-23, IL-17A, IL-17F, IL-17RA).
• Analysis of clinical data and treatment outcomes associated with these targeted therapies.

Main Results:

• New molecules targeting IL-23 or downstream IL-17 (ligands or receptor subunits) demonstrate superior efficacy in psoriasis.
• Different targets within the IL-17 pathway (IL-17A, IL-17F, IL-17RA) present unique clinical profiles.
• The IL-23/IL-17 pathway inhibitors offer a more disease-specific treatment strategy.

Conclusions:

• Inhibitors of the IL-23/IL-17 pathway represent a significant advancement in psoriasis management.
• Physicians require comprehensive knowledge of these agents' mechanisms, benefits, and limitations for optimal patient selection.
• Further understanding of IL-17's role in comorbidities is essential for holistic patient care.