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Interleukin 23: Pathogenetic Involvement and Therapeutic Target for Ulcerative Colitis
Laura Parisio1, Giuseppe Cuccia2, Anna Giudice3
1UOS Gastroenterologia, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy.
Journal of Clinical Medicine
|July 12, 2025
Summary
Interleukin-23 (IL-23) inhibitors effectively treat ulcerative colitis (UC), improving symptoms and endoscopic healing with minimal side effects. Their optimal use in UC treatment algorithms requires further study.
Area of Science:
- Immunology and Gastroenterology
- Pharmacology of inflammatory diseases
Background:
- Interleukin-23 (IL-23) is a critical cytokine in immuno-mediated inflammatory diseases.
- Ulcerative colitis (UC) pathogenesis involves IL-23.
- Several IL-23 targeted therapies have been developed.
Purpose of the Study:
- To review clinical data on IL-23 inhibitors for ulcerative colitis (UC).
- To provide perspectives on optimal clinical use of IL-23 inhibitors in UC.
- To discuss challenges in positioning IL-23 inhibitors within UC treatment algorithms.
Main Methods:
- Review of clinical trial data for IL-23 inhibitors in UC.
- Analysis of efficacy, safety, and patient-reported outcomes.
- Discussion of therapeutic positioning and potential combination strategies.
Main Results:
- Mirikizumab, risankizumab, and guselkumab demonstrated efficacy in UC clinical trials.
- These IL-23 inhibitors alleviate symptoms and induce endoscopic/histologic improvement.
- Adverse events were infrequent; bowel urgency was a key patient-reported outcome.
Conclusions:
- IL-23 inhibitors show a favorable efficacy and safety profile for UC treatment.
- Optimal integration into UC therapeutic strategies is challenging due to lack of biomarkers and comparative data.
- Potential roles exist in combination therapy for refractory UC patients.
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