Since the identification of high levels of interleukin 23 (IL- 23) in psoriasis lesional skin, as well as finding that IL-23 was the most important source of the p40 subunit shared by IL-12 and IL-23, significant effort has been made in identifying potential new drugs that specifically block the unique IL-23 p19 subunit. At this time, 2 inhibitors of IL-23 p19 have been approved by the United States Food and Drug Administration, guselkumab and tildrakizumab. Two other agents, risankizumab and mirikizumab, have completed phase 3 and phase 2 of development, respectively. Pivotal trials in the development of these agents and clinical use of the approved agents are discussed. Thus far, this class of medications seems to provide a high level of efficacy, along with infrequent dosing and very favorable safety results.
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