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Targeting the IL-23/IL-17 Pathway in Psoriasis: the Search for the Good, the Bad and the Ugly

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Abstract

New promising treatments have been developed for psoriasis that target different parts of the interleukin (IL)-23/IL-17 pathway. This approach is believed to be more disease specific, and sparing the T helper 1 pathway might prevent serious long-term adverse events. Moreover, superior Psoriasis Area and Severity Index improvements are observed, which has redefined treatment goals in psoriasis. The new molecules can be divided into different categories, according to the target: blocking agents can target the upstream cytokine IL-23 or the downstream IL-17. In the latter, a variety of targets exist, such as the ligands IL-17A and IL-17F, or a combination thereof, or a subunit of the receptor, IL-17RA. Each target seems to have its own set of advantages and pitfalls, which will impact the treatment decision in clinical practice. In this review, we summarize the current knowledge on the different inhibitors of the IL-23/IL-17 pathway. Furthermore, we briefly discuss the role of IL-17 in other diseases and comorbidities. Finally, we discuss how comprehensive knowledge is needed for the prescribing physician in order to make the most appropriate therapeutic choice for each individual patient.

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Acknowledgement

This research is funded by a research grant to Nanja van Geel from the Scientific Research Foundation-Flanders (FWO Senior Clinical Investigator; grant number: 1831512 N).

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  1. S. Mylle and L. Grine contributed equally as first authors.

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  1. Department of Dermatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Sofie Mylle, Lynda Grine, Reinhart Speeckaert, Jo L.W. Lambert & Nanja van Geel

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  1. Sofie Mylle
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Correspondence to Reinhart Speeckaert.

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Sofie Mylle, Reinhart Speeckaert and Nanja van Geel declare no conflict of interest. Jo Lambert has received unrestricted educational grants, board and speaker’s fees from AbbVie, Celgene, Eli Lilly, Janssen Cilag, Leo Pharma, Novartis, Pfizer, and UCB. Lynda Grine has received a speaker’s fee from AbbVie.

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Mylle, S., Grine, L., Speeckaert, R. et al. Targeting the IL-23/IL-17 Pathway in Psoriasis: the Search for the Good, the Bad and the Ugly. Am J Clin Dermatol 19, 625–637 (2018). https://doi.org/10.1007/s40257-018-0366-5

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