The IL-23/IL-17 axis is central to the pathogenesis of psoriatic disease, and therapeutic targeting of these pathways has led to a paradigm shift in treatment approaches. However, it is not always clear whether an IL-23 or an IL-17 inhibitor would be more appropriate.

The PsOPsA Hub spoke with Peter Nash, Griffith University, Queensland, AU. We asked, What clinical factors guide your decision to initiate an IL-23 or IL-17 inhibitor in patients with psoriatic disease?

This educational resource is independently supported by UCB. All content was developed by SES in collaboration with an expert steering committee. Funders were allowed no influence on the content of this resource.

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During the PsOPsA Hub Steering Committee Meeting on July 16, 2025, Peter Nash, Griffith University, Queensland, AU, chaired a discussion on dual inhibition of IL-17A and IL-17F in psoriatic disease. The discussion also featured Paolo Gisondi, Ulrich Mrowietz, Yukari Okubo, and Jody Quinn.

Key learnings:

Treatment decisions in psoriatic disease are guided by both administrative and clinical factors.

o Administratively, biosimilars are recommended as first choice due to cost constraints. If treatment fails, other classes such as IL-23 (p19) or IL-17 inhibitors may be considered.

o Clinically, treatment decisions are mainly driven by disease severity. Dual IL-17A/F inhibitors are favored for patients with severe, resistant, or diffuse psoriasis, as well as in those presenting with arthralgia – even in the absence of a confirmed PsA diagnosis – compared with adalimumab and other agents.

In Germany, all biologics are accessible, including bimekizumab.

o IL-17 inhibitors, particularly bimekizumab and ixekizumab, are the first choice for PsA.

o Bimekizumab is also preferred after failure of other biologics or other treatments, and in severe skin disease.

o Candida infections, especially folliculitis, remain a concern, particularly during the first year of treatment. Management is further complicated by the need to avoid azole antifungals, such as fluconazole, due to CYP450-mediated drug–drug interactions.

o Despite this, bimekizumab remains a highly effective option for skin, joint, and nail involvement.

In Japan, IL-17A or IL-23 inhibitors are typically used as first-line therapy for severe skin disease, while dual IL-17A/F inhibitors are reserved for use after treatment failure. For difficult-to-manage PsA, dual inhibitors are often preferred as first-line therapy.

o Real-world incidence of Candida appears to be reduced with consistent oral hygiene.

Patient experience of biologics found bimekizumab to give relief from psoriatic pain, and scalp and hand psoriasis, but also suggested that treatments spaced beyond 4 weeks may be to be less effective.

This independent educational activity was supported by UCB. All content was developed independently. The funder was allowed no influence on the content of this activity.

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During the PsOPsA Hub Steering Committee Meeting on July 16, 2025, Paolo Gisondi, University Hospital of Verona, Verona, IT, chaired a discussion on selective TYK2 inhibition for the treatment of psoriatic disease. The discussion also featured Ulrich Mrowietz, Peter Nash, and Yukari Okubo.

Discussion

• The clinical utility of TYK2 inhibitors is often questioned, given their moderate efficacy (PASI 90 response rates less than 50%), and relatively higher incidence of AEs (e.g. folliculitis, nasopharyngitis) and infections, especially when compared with IL-23 p19 inhibitors.

• Oral administration of deucravacitinib and zasocitinib offers practical advantages, though patient preferences vary by region. Oral agents are favored in Japan and Australia for convenience, easier storage, or for patients recovering from AEs associated with biologics (especially with tumor necrosis factor inhibitors), while in Germany, injectables are preferred for their greater efficacy, less frequent dosing, and lower psychological burden.

• In Australia, oral agents remain integral to PsA management, particularly as bridging therapies before biologics. Deucravacitinib is generally well-tolerated in patients with mild-to-moderate PsA and is often used off-label in combination with traditional biologics for treatment-refractory cases.

• In Japan, apremilast is typically prescribed first due to its lower cost, with TYK2 inhibitors considered upon failure. For moderate-to-severe PsO, earlier initiation of TYK2 inhibitors is being explored, while biologics remain the preferred option in PsA.

• Real-world data from Germany indicate the highest drug survival with IL-23 p19 inhibitors, followed by IL-17 inhibitors and adalimumab. In contrast, oral treatments including apremilast and deucravacitinib show lower drug survival, due to factors such as limited efficacy and AEs, meaning they are less favorable from both clinical and economic perspectives.

This independent educational activity is supported by Takeda. All content was developed independently. The funder was allowed no influence on the content of this activity.

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