Can IL-23 Inhibitors Change the Conversation About Psoriasis Remission?

Psoriasis treatment strategies were a key focus of discussion at the American Academy of Dermatology (AAD) annual meeting. MedPage Today spoke with E. James Song, MD, of Frontier Dermatology in Washington, about whether interleukin (IL)-23 inhibitors may move the field closer to true remission.

Drawing on recent data and clinical experience, he discusses the potential benefits of early intervention, and what this could mean for durability of response.

Following is a transcript of his remarks:

We just recently published our definition, the National Psoriasis Foundation’s, definition of remission for psoriasis, and it was on-treatment remission, which is maybe a little bit foreign to us as dermatologists because we think of remission off of therapy, but in different disease states, they do use on-treatment as a remission definition.

That being said, I think the best chance we do have at remission is with an interleukin-23 inhibitor and it’s treating patients early in their disease course. And this was something we actually talked about in our symposium, that there’s been a number of case reports of patients with guttate psoriasis, but you get them early because they get strep throat, explosive [onset], they walk into the dermatologist, you give them a couple doses of an interleukin-23 inhibitor and bam, they’re clear and they stay clear and it does not come back.

And so there’s been a number of studies now. We mentioned one with guselkumab [Tremfya], which is an interleukin-23 inhibitor, looking at whether you can take super responders, which means you’re completely clear for at least two visits from week 20 to 28, and then you go from either every-8-week guselkumab, which is the label dose, down to every 16 weeks. … And we found that those patients were still able to go every 16 weeks and had a very similar level of psoriasis control.

And then when you stopped the treatment altogether, which happened after 1 year, those patients who had psoriasis for the shortest duration, so less than 15 months, were the most likely to have their psoriasis take a very long time, we’re talking like a year-plus, for it to come back.

And that was actually supported by Dr. Andy Blauvelt’s trial with risankizumab [Skyrizi]. He used actually much higher doses of an IL-23 inhibitor, actually two to four times higher than psoriasis. And he just gave them a couple doses of risankizumab and their psoriasis stayed clear for a very, very long time.

And so I think that it is interesting, but also exciting, that if we use these drugs early on in that window of opportunity, maybe just maybe we could actually get closer to getting to a remission off of treatment.