Department of Dermatology and Venereology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria.
Medical University of Vienna, Vienna, Austria.
Sci Rep. 2022 Sep 5;12(1):15078. doi: 10.1038/s41598-022-18790-9.
With the introduction of the latest class of biologic drugs targeting interleukin (IL)-23p19, three new, highly effective drugs can be used for the treatment of chronic plaque psoriasis. However, poorer skin improvement as well as higher rates of serious adverse events have been reported for patients under real-world conditions (outside clinical trials). This accounts especially for patients who have already been treated with biologic drugs. We therefore aimed to determine effectiveness and safety of IL-23p19 inhibitors in real-world patients by analysing data from the Psoriasis Registry Austria (PsoRA) in this observational, retrospective, multicentre cohort study. Data for 197 patients (52.3% biologic-non-naïve), who were treated with anti-IL-23p19 antibodies (127 guselkumab, 55 risankizumab and 15 tildrakizumab) for at least 3 months, were eligible for analysis. In general, biologic-non-naïve patients displayed a less favourable response to anti-IL-23 treatment as compared to biologic-naïve patients. However, after correction for previous biologic exposure, few differences in PASI improvement were detected among biologic-naïve and -non-naïve patients treated with different IL-23p19 inhibitors. This indicates that treatment effectiveness is not related to the class of the previously administered therapy in biologic-non-naïve patients. Therefore, IL-23p19 inhibitors represent a promising treatment alternative for patients who have not responded to previous biologics. However, as with other biologic agents (including IL-17 inhibitors), we did not observe an entirely satisfactory treatment response (i.e. PASI < 3 and/or PASI 75) to anti-IL-23 treatment in one out of four to five patients. Adverse events (mainly non-severe infections) were observed in 23 (11.7%) patients with no major differences regarding the administered IL-23 inhibitor or previous biologic exposure.
随着最新一类靶向白细胞介素 (IL)-23p19 的生物制剂药物的引入，三种新型、高效的药物可用于治疗慢性斑块型银屑病。然而，在真实世界环境（临床试验之外）下，患者的皮肤改善情况较差，且严重不良事件发生率较高。这尤其适用于已经接受生物制剂治疗的患者。因此，我们旨在通过分析奥地利银屑病登记处（PsoRA）的观察性、回顾性、多中心队列研究数据，确定 IL-23p19 抑制剂在真实世界患者中的疗效和安全性。这项研究共纳入了 197 名患者（52.3%为生物制剂初治患者），他们至少接受了 3 个月的抗 IL-23p19 抗体治疗（127 名古塞鲁单抗、55 名里司库单抗和 15 名替西利珠单抗）。总体而言，与生物制剂初治患者相比，生物制剂治疗史患者的抗 IL-23 治疗反应较差。然而，在校正先前生物制剂暴露后，不同 IL-23p19 抑制剂治疗的生物制剂初治和非初治患者的 PASI 改善程度差异较小。这表明在生物制剂非初治患者中，治疗效果与先前给予的治疗药物类别无关。因此，IL-23p19 抑制剂是一种有前途的治疗选择，可用于先前生物制剂治疗无效的患者。然而，与其他生物制剂药物（包括 IL-17 抑制剂）一样，我们观察到抗 IL-23 治疗的治疗反应并不完全令人满意（即 PASI < 3 和/或 PASI 75），约四到五分之一的患者。观察到 23 名（11.7%）患者发生不良反应（主要为非严重感染），在给予的 IL-23 抑制剂或先前的生物制剂暴露方面无显著差异。
