IL-23 inhibitors in psoriasis treatment: Current perspectives and emerging horizons

Interleukin-23 (IL-23) inhibitors have become a crucial tool in the treatment of psoriasis. This group of genetically engineered biological drugs offers promising prospects for achieving long-term remission and improving patients’ quality of life. Modern therapies, such as guselkumab, demonstrate high efficacy in achieving complete skin clearance (PASI 90/100) and maintaining treatment outcomes, even in patients with a long history of the disease or previous failure with TNF or IL-17 inhibitors. Particularly noteworthy are recent studies aimed at confirming the concept of disease modification. According to the latest findings, early intervention using IL-23 inhibitors accelerates remission and increases the frequency of super-response, especially in patients with a short history of severe psoriasis (≤2 years). The concept of disease modification (DM), defined as a sustainable change in the pathophysiology of psoriasis that minimizes the need for ongoing treatment, underscores the importance of IL-23 inhibitors. Key criteria for DM include reducing BSA to <1% and achieving PGA 0/1 within 12 months without active therapy. Additionally, IL-23 inhibitors have been shown to reduce systemic inflammation and improve control over subclinical psoriatic disease activity. These advancements open new horizons for a personalized approach to psoriasis treatment, enabling not only symptom control but also altering the course of the disease. Future research should focus on developing clinically applicable biomarkers for assessing inflammatory activity, optimizing strategies for transitioning between drug classes, and investigating long-term effects following therapy cessation. IL-23 inhibitors are solidifying their role as a cornerstone of modern therapeutic regimens, providing physicians and patients with new opportunities to combat psoriasis. 

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