IL-23 Inhibitors Outperform Placebo for Treatment of Psoriatic Arthritis, Meta-Analysis Shows

Interleukin (IL)-23 inhibitors effectively improve joint disease activity in patients with psoriatic arthritis (PsA) with a favorable safety profile, according to a meta-analysis of six randomized controlled trials published in Immunologic Research.

“IL-23 inhibitors have the potential to be a promising therapeutic option, especially for PsA patients who have an insufficient response to conventional synthetic disease-modifying antirheumatic drugs,” researchers wrote.

Of the half-dozen randomized controlled trials in the meta-analysis, three focused on guselkumab, two on risankizumab, and one on tildrakizumab. All were placebo-controlled and reported on measures of response at 24 weeks, in addition to safety outcomes. Nearly 3000 patients were included in the meta-analysis.

The rate of American College of Rheumatology (ACR) 20 response, which was the primary outcome, was significantly higher for the IL-23 inhibitor group compared with the placebo group. Researchers reported a pooled relative risk of 1.74.

Additionally, IL-23 inhibitors outperformed placebo in a handful of secondary outcomes, including ACR50 response rate (2.49 relative risk), ACR70 response rate (2.89 relative risk), Psoriasis Area Severity Index 90 response rate (6.11 relative risk), and minimal disease activity response rate (3.19 relative risk). 

The risk of adverse events and serious adverse events did not differ between the IL-23 inhibitor and placebo groups. Although more patients in the IL-23 inhibitor group had elevated transaminases, reactions were generally grade one or two, researchers reported.

“Since the observation period was limited to 24 weeks, we could not assess the long-term safety of IL-23 inhibitors in PsA patients,” the authors noted. “Therefore, the incidence of adverse events from long-term IL-23 inhibitor use remains to be investigated.”

Reference:
Huang X, Shentu H, He Y, et al. Efficacy and safety of IL-23 inhibitors in the treatment of psoriatic arthritis: a meta-analysis based on randomized controlled trials. Immunol Res. Published online February 22, 2023. doi:10.1007/s12026-023-09366-4