Background and Importance Interleukin-23 (IL-23) is a cytokine involved in inflammatory and immune responses in psoriasis. Novel therapies such as tildrakizumab, guselkumab, and risankizumab inhibit the IL-23-receptor interaction.

Aim and Objectives To compare the effectiveness between IL-23 inhibitors in patients with psoriasis in a third level hospital.

Material and Methods An observational, retrospective, descriptive study was conducted in patients with psoriasis treated with tildrakizumab, guselkumab or risankizumab between August-20 and August-22. Demographic, clinical, and treatment specific variables were collected. Effectiveness was determined through the comparison of psoriasis area severity index (PASI) prior starting IL-23 inhibitor and after the first visit (between weeks 4 and 16 after start).

Results The study included 58 patients [62.1% men, median age 51 (23-83) years] out of whom 8 (13.8%) had psoriatic arthritis comorbidity, 11 (18.9%) were treated with tildrakizumab, 20 (34.4%) with guselkumab and 27 (46.5%) with risankizumab. Median of treatment line was 3 (2-5) with tildrakizumab and guselkumab, and 2 (1-12) with risankizumab. Adalimumab was the most common previous therapy (54.5%, n=6 for tildrakizumab; 40.0%, n=8 for guselkumab; 38.5%, n=10 for risankizumab) and the median time of treatment with previous drug was 58.4 (9.8-665.0), 64.5 (1.5-921.0) and 46.6 (0.0-299.0) weeks, respectively. Reasons for switching to IL-23 inhibitors were treatment failure (100.0%, n=11 for tildrakizumab; 85.0%, n=17 for guselkumab; 84.6%, n=22 for risankizumab), adverse events (15.0%, n=3 for guselkumab; 11.5%, n=3 for risankizumab) or drug interaction (3.8%, n=1 for risankizumab). Median time of treatment with IL-23 inhibitor was 41.9 (16.9-68.0), 44.1 (9.2-168.0) and 26.3 (14.9-96.1) weeks for tildrakizumab, guselkumab and risankizumab, respectively. Median PASI before switching to IL-23 inhibitor treatments vs after first visit were 7.7 (3.3-10.8) vs 1.4 (0.0-5.2) for tildrakizumab, 8.9 (1.0-29.1) vs 0.9 (0.0-6.8) for guselkumab and 7.8 (2.8-21.8) vs 1.2 (0.0-10.4) for risankizumab. 7 patients (35.0%) and 10 patients (37.0%) in treatment with guselkumab and risankizumab respectively achieved PASI 0, while only 3 patients (27.3%) in treatment with tildrakizumab did.

Conclusion and Relevance The duration of the previous treatment was prolonged. Treatment failure was the main reason to initiate an IL-23 inhibitor treatment. Data suggest that guselkumab and risankizumab could be more effective treatments between 4 and 16 weeks compared to tildrakizumab.

Conflict of Interest No conflict of interest