What are examples of interleukin‑17 and interleukin‑23 inhibitors used to treat plaque psoriasis?

IL-17 and IL-23 Inhibitors for Plaque Psoriasis

The FDA-approved IL-17 inhibitors for plaque psoriasis are secukinumab, ixekizumab, and brodalumab; the IL-23 inhibitors are guselkumab, risankizumab, and tildrakizumab. 1

IL-17 Inhibitors

Secukinumab

• Mechanism: Monoclonal antibody targeting IL-17A 1
• Dosing: 300 mg subcutaneous injection at weeks 0,1,2,3, and 4, then 300 mg every 4 weeks for maintenance 1
• Strength of recommendation: Grade A for moderate-to-severe plaque psoriasis 1
• Key advantage: The 300 mg dose is more effective than 150 mg and equally safe 1
• Special indications: FDA-approved for psoriatic arthritis; also effective for nail, scalp, and palmoplantar psoriasis 1

Ixekizumab

• Mechanism: IL-17 antagonist 1
• Dosing: 160 mg subcutaneous injection at week 0, followed by 80 mg at weeks 2,4,6,8,10, and 12, then 80 mg every 4 weeks (some patients may require every 2 weeks for maintenance) 1
• Strength of recommendation: Grade A for moderate-to-severe plaque psoriasis 1
• Special indications: FDA-approved for psoriatic arthritis; effective for scalp, nail, erythrodermic, and generalized pustular psoriasis 1

Brodalumab

• Mechanism: Binds to IL-17 receptor A, blocking IL-17A, IL-17F, IL-17A/F, and IL-17E 1
• Dosing: 210 mg subcutaneous injection at weeks 0,1, and 2, then 210 mg every 2 weeks 1
• Strength of recommendation: Grade A for moderate-to-severe plaque psoriasis 1
• Important caveat: Subject to REMS program; contraindicated in patients with inflammatory bowel disease 1

IL-23 Inhibitors

Guselkumab

• Mechanism: Monoclonal antibody targeting IL-23 p19 subunit 1
• Dosing: 100 mg subcutaneous injection at weeks 0 and 4, then every 8 weeks 1
• Strength of recommendation: Grade A for moderate-to-severe plaque psoriasis 1
• Special indications: Effective for scalp, nail, and palmoplantar psoriasis 1

Risankizumab

• Mechanism: Targets IL-23 p19 subunit 1
• Clinical performance: Demonstrated superior efficacy in head-to-head trials, with higher PASI 100 achievement rates compared to ustekinumab 1

Tildrakizumab

• Mechanism: Humanized IgG1 monoclonal antibody targeting IL-23 p19 subunit 1
• Dosing: 100 mg physician-administered subcutaneous injection at weeks 0 and 4, then every 12 weeks 1
• Strength of recommendation: Grade A for moderate-to-severe plaque psoriasis 1
• Key advantage: Longest dosing interval (every 12 weeks) 1

Critical Clinical Considerations

Time to assess response: Evaluate treatment efficacy at 12 weeks for IL-23 inhibitors and 12-16 weeks for IL-17 inhibitors 1

Important safety distinction: IL-17 inhibitors (brodalumab and secukinumab specifically) are contraindicated in patients with inflammatory bowel disease due to risk of reactivation or worsening 1. This is a critical screening point before initiating therapy.

Infection risk: All IL-17 inhibitors carry increased risk of candidiasis, particularly mucocutaneous infections 1. Screen for active tuberculosis before initiating any of these agents 1.

Psoriatic arthritis consideration: Both secukinumab and ixekizumab have FDA approval for psoriatic arthritis, while IL-23 inhibitors have varying levels of evidence for joint disease 1. Recent evidence suggests IL-17 inhibitors may have superior effects on systemic inflammation markers compared to IL-23 inhibitors 2.