High 12-month persistence and effectiveness of IL-23 inhibitors in psoriatic arthritis: a multicenter retrospective real-world study from Argentina

Abstract

Interleukin-23 inhibitors (IL-23i) are effective in psoriatic arthritis (PsA) in randomized trials; however, real-world data from Latin America remain limited. We described baseline characteristics and treatment line at IL-23i initiation, physician-reported reasons for selecting IL-23 inhibition, and pragmatic effectiveness and persistence at 6 and 12 months in Argentina. Multicenter, observational, retrospective cohort study across seven Argentine sites. Adults with rheumatologist-diagnosed PsA initiating IL-23i (guselkumab or risankizumab) in routine care were included. Baseline demographics, disease duration, domains, key activity measures, prior advanced therapy lines, and physician-reported rationale were abstracted from records. Patients were assessed at ~ 6 and 12 months. Primary outcome was physician-recorded minimal disease activity (MDA); persistence was remaining on IL-23i. Analyses were descriptive, with no inferential/predictive analyses due to sample size. Fifty-five patients were included (48% female; age 56 ± 11 years). Mean PsA duration before IL-23i was 7.7 ± 5.8 years and psoriasis duration 19 ± 11 years. IL-23i was initiated as the 1st, 2nd, or ≥ 3rd advanced line in 26%, 34%, and 39%, respectively; prior TNF inhibitor exposure was 75% and IL-17 inhibitor exposure 25%. Domain involvement was frequent (peripheral 95%, skin 91%, nails 44%, enthesitis 43%, dactylitis 13%, axial 17%). Physicians selected IL-23i mainly for safety (73.9%) and expected skin efficacy (69.6%). MDA was achieved by 70% at 6 months (90% persistence) and 75% at 12 months (80% persistence). In Argentine routine care, IL-23 inhibition achieved high MDA rates with substantial 12-month persistence in complex, treatment-experienced PsA, supporting its pragmatic use in daily practice.

Keywords: Argentina; Biological therapy; Guselkumab; Interleukin-23; Minimal disease activity; Multicenter study; Psoriatic arthritis; Real-world evidence; Retrospective studies; Risankizumab; Treatment persistence.