Journal
ANNALS OF THE RHEUMATIC DISEASES
Volume 81, Issue 4, Pages 466-468Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2021-221422
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Three monoclonal antibodies targeting interleukin-23 have been approved for psoriasis treatment, with two also approved for psoriatic arthritis. However, they have shown to be ineffective in axial spondyloarthritis and may be due to generic effects rather than specific inflammation.
The three monoclonal antibodies ustekinumab, guselkumab and risankizumab targeting the p 40 or the 19 subunit of interleukin -23 have now been approved for the indication psoriasis and the former two also for psoriatic arthritis (PsA). Ustekinumab and risankizumab have appeared ineffective in randomised controlled trials with patients with axial spondyloarthritis (axSpA), but post-hoc analyses of PsA trials have now suggested that they may improve back pain symptoms potentially induced by axial inflammation based on PsA. Here we argue that, based on the absence of efficacy in axSpA, this is unlikely and more probably due to generic, non-specific effects, which are not adequately covered by the tools developed for the assessment of inflammation in axSpA.
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