Journal
EXPERT OPINION ON BIOLOGICAL THERAPY
Volume 22, Issue 7, Pages 843-853Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/14712598.2022.2090834
Keywords
interleukin 23; psoriatic arthritis; axial spondyloarthritis; anti-IL-23 drugs
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IL-23 plays a protective role against bacterial and fungal infections, but its dysregulation can lead to inflammatory diseases. Drugs targeting IL-23 have shown excellent efficacy and safety in treating PsA, but lack the same efficacy in AS, with the reasons still unknown.
Introduction Interleukin 23 (IL-23) is a pro-inflammatory cytokine that plays a protective role against bacterial and fungal infections. However, the dysregulation of the IL-23/IL-17 axis provides a solid substrate for the development of various inflammatory diseases, such as psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Areas covered In different clinical trials, several drugs against IL-23 have shown efficacy and safety toward PsA, with excellent results on skin and joint scores. However, the same drugs did not show the same efficacy in AS, suggesting that IL-23 may not be a relevant driver of the pathobiology and clinical symptoms of active axial spondyloarthritis (axSpA). Expert opinion These drugs have shown an excellent efficacy and a good safety profile toward PsA, while in AS the efficacy of the IL-23 blockade is lacking for reasons not yet known. Several hypotheses have been reported, but further studies will be needed for a greater understanding. This suggests the involvement of pathways or mechanisms for the development of SpA that remain unknown. In order to allow a wide use of IL-23 inhibitors, further clinical trials and long-term prospective studies are necessary.
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