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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Plaque psoriasis (PsO) is an immune-mediated inflammatory skin disease that affects around 2–3% of the global population. Up to one third of patients with PsO develop psoriatic arthritis (PsA), a chronic inflammatory condition characterized by diverse clinical manifestations, including dactylitis, enthesitis, peripheral synovitis, and axial involvement. Therefore, early recognition of PsA is crucial and may lead to improved clinical outcomes.

The PsOPsA Hub spoke with Laure Gossec, Sorbonne Université and Pitié-Salpêtrière, Paris, FR. We asked, How can patients at risk of developing PsA be identified and why is this important? She discussed the risk of progression to PsA in patients with PsO, the potential impact of early intervention on disease outcomes, and the current treatment landscape for early PsA.

Key Learnings:

Identification of patients with PsO at risk of developing PsA:

• Around one third of patients with PsO will develop PsA.

• Risk factors for PsA include obesity, nail involvement, and family history of PsA; of these, obesity is the only modifiable factor, making weight management important in patients with PsO.

The impact of early treatment on PsA outcomes:

• The aim of pre-PsA treatment is to intercept and modify disease progression, in order to maximize quality of life (QoL), and avoid structural damage.

• The European Alliance of Associations for Rheumatology (EULAR) criteria facilitate identification of a population of patients with PsO who are at risk of developing PsA in clinical trials.

• Results from the ongoing PAMPA randomized clinical trial (NCT05004727), investigating guselkumab for preventing the onset of PsA in patients at high risk, are not yet available; however, observational data suggest that biologic therapies, such as interleukin (IL)-17 and IL-23 inhibitors, appear to be effective in preventing the onset of PsA by up to 80%.

• Early intervention of PsA has the potential to improve clinical prognosis by reducing pain and enhancing QoL, while also preventing progression to polyarticular disease which is predictive of structural damage and long-term functional impairment.

The current treatment landscape for early PsA:

• Treatment guidelines for very early PsA are currently lacking; however, all therapies approved and recommended for established PsA can be used in early disease, including conventional synthetic disease-modifying antirheumatic drugs (DMARDs); targeted synthetic DMARDs (such as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) inhibitors); and biologics (such as TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors).

• For patients with early PsA or oligoarticular disease, which is common presentation in early PsA, a less aggressive approach with conventional synthetic DMARDs may be appropriate, in line with EULAR recommendations.

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 Psoriasis Hub Steering Committee meeting in May 2024, Alice Gottlieb chaired a session on patient and physician expectations – from diagnosis to the treatment of psoriatic disease. The discussion featured patients Jody Quinn and Hellen Wangui.

In the first part of the discussion, diagnosis was discussed. Quinn and Wangui also shared about their journey to diagnosis and associated barriers in diagnosis. Gottlieb discussed why diagnosis can be delayed and how this could be improved.

In the second part of the discussion, treatment of psoriatic disease was discussed, including difficulties in access to treatment, personal experiences with treatment, and side effects of treatment. Quinn and Wangui also shared how physicians could have made their treatment journey easier.

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During the Psoriasis Hub Steering Committee Meeting in May 2024, key opinion leaders met to discuss the current treatment landscape for patients with psoriasis and PsA.

The recorded discussion was chaired by Paolo Gisondi, and featured Alice Gottlieb and Yukari Okubo. The steering committee discussed recent approvals of systemic agents for psoriatic disease, including efficacy and safety data of bimekizumab and deucravacitinib. They also spoke about how to avoid and treat oral candidiasis infections in patients treated with interleukin 17 inhibitors.

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During the 25th World Congress of Dermatology 2023, the Psoriasis and Psoriatic Arthritis Hub was pleased to speak with Mark Lebwohl, Mount Sinai, New York, U.S. We asked about the long-term efficacy of deucravacitinib.

Lebwohl discusses the data at 112 weeks of continuous deucravacitinib treatment. He also mentions how, by blocking tyrosine kinase 2, deucravacitinib differs from standard therapies, maintaining a high level of efficacy over time.

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During the 31st European Academy of Dermatology and Venereology (EADV) Congress, the Psoriasis and Psoriatic Arthritis Hub was pleased to speak to Paolo Gisondi, University Hospital of Verona, Verona, IT, and Jose-Manuel Carrascosa, Germans Trias i Pujol University Hospital, Barcelona, ES. We asked, Is a treatment goal of PASI100 appropriate in psoriasis management?

Carrascosa opens by discussing PASI100 as an optimal treatment goal but notes that this may not be achievable in all patients and may be a possible cause of disappointment when there is failure to meet it. Gisondi agrees and goes on to highlight the importance of distinguishing between an optimal treatment target and a realistic treatment target. He suggests that more achievable goals, such as PASI90, may be more appropriate. Gisondi and Carrascosa finish by discussing the importance of considering other outcomes, such as quality of life and disease modification, when assessing treatment goals.

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