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IL-23 Inhibitors in Psoriasis: What Have We Learnt so Far?

Matteo Megna1, Michela D'Agostino1, Federica Feo1

  • 1Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Journal of Inflammation Research
|February 19, 2026
PubMed
Summary

Interleukin-23 (IL-23) inhibitors offer effective, durable treatment for moderate-to-severe plaque psoriasis. Real-world data confirm their safety and efficacy across diverse patient groups and challenging disease sites.

Keywords:
IL-23 inhibitorsguselkumabpsoriasisreal-world evidencerisankizumabtildrakizumab

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Area of Science:

  • Immunology
  • Dermatology
  • Pharmacology

Background:

  • The IL-23/Th17 axis is central to moderate-to-severe plaque psoriasis pathogenesis.
  • IL-23 inhibitors targeting the p19 subunit offer a targeted approach to suppress inflammation.
  • Randomized trials show high efficacy and safety, but real-world data are needed for complex populations.

Purpose of the Study:

  • To review real-world evidence on the long-term efficacy, durability, and safety of IL-23 inhibitors in psoriasis.
  • To evaluate the performance of IL-23 inhibitors in special and comorbid patient populations.
  • To synthesize trial and real-world data for clinical guidance on IL-23 inhibitor use.

Main Methods:

  • Narrative review of expanding real-world evidence.
  • Integration of data from pivotal randomized trials and large observational cohorts.
  • Focus on long-term outcomes, drug survival, and safety in diverse patient groups.

Main Results:

  • Real-world studies confirm high effectiveness in elderly, comorbid, and heavily pre-treated patients.
  • IL-23 inhibitors demonstrate excellent treatment persistence and favorable safety in patients with specific comorbidities.
  • Consistent efficacy observed in difficult-to-treat areas like scalp, nails, and palmoplantar regions.

Conclusions:

  • IL-23 inhibitors are versatile, reliable long-term treatments for psoriasis, addressing unmet needs in clinical practice.
  • Real-world data support sustained efficacy and safety across heterogeneous patient populations.
  • Subtle differences exist among agents, with guselkumab and risankizumab showing faster early responses, and tildrakizumab offering dosing flexibility.