Off-label dermatologic uses of IL-23 inhibitors

Area of Science:

• Dermatology
• Immunology
• Pharmacology

Background:

• Interleukin-23 (IL-23) is implicated in various inflammatory skin diseases.
• Current FDA-approved IL-23 inhibitors (guselkumab, tildrakizumab, risankizumab) are indicated only for psoriasis.
• Elevated IL-23 levels are observed in several non-psoriatic dermatologic conditions.

Purpose of the Study:

• To review and interpret existing literature on the off-label use of IL-23 inhibitors in dermatology.
• To explore the potential of IL-23 inhibitors for treating inflammatory skin conditions beyond psoriasis.

Main Methods:

• Searched PubMed and ClinicalTrials.gov for relevant studies.
• Included clinical trials, observational studies, case series, and case reports.
• Focused on the use of guselkumab, tildrakizumab, and risankizumab for non-psoriatic conditions.

Main Results:

• Promising responses observed in hidradenitis suppurativa, lichen planus, pityriasis rubra pilaris, pyoderma gangrenosum, and others.
• Conditions like dissecting cellulitis, congenital ichthyosiform erythroderma, and alopecia also showed potential benefits.
• Lupus erythematosus tumidus and Stewart-Treves angiosarcoma were among the conditions with reported responses.

Conclusions:

• IL-23 inhibitors may be effective for treating various inflammatory dermatoses due to shared pathways with psoriasis.
• Current findings suggest potential therapeutic benefits for off-label indications.
• Large-scale, randomized clinical trials are essential to validate efficacy and safety for these conditions.