Comparative Analysis of the Long-Term Real-World Efficacy of Interleukin-17 Inhibitors in a Cohort of Patients with Moderate-to-Severe Psoriasis Treated in Poland

Abstract

Background: Bimekizumab, secukinumab, and ixekizumab are IL-17-targeting biologics approved for the treatment of moderate-to-severe plaque psoriasis. While secukinumab and ixekizumab selectively inhibit IL-17A, bimekizumab targets both IL-17A and IL-17F, potentially providing greater anti-inflammatory efficacy. This study aimed to compare the real-world effectiveness, safety, and tolerability of these agents in a Polish dermatology center between 2019 and 2024. Methods: We conducted a retrospective analysis of 98 patients meeting at least one of the following criteria: PASI ≥ 10, BSA ≥ 10, DLQI ≥ 10, or involvement of special areas with inadequate response or contraindications to ≥2 systemic therapies. Patients with prior exposure only to IL-17 inhibitors were excluded. PASI, BSA, and DLQI scores were recorded at baseline, week 4, and week 12. Due to differences in dosing schedules, outcomes were aligned using standardized timepoints and exponential modeling of continuous response trajectories. Mixed-effects ANOVA was used to assess the influence of baseline factors (age, BMI, PsA status) on treatment outcomes. Adverse events were documented at each monthly follow-up visit. Results: Bimekizumab showed the greatest effect size for PASI reduction (Hedges' g = 3.662), followed by secukinumab (2.813) and ixekizumab (1.986). Exponential modeling revealed a steeper response trajectory with bimekizumab (intercept = 0.289), suggesting a more rapid PASI improvement. The efficacy of bimekizumab was particularly notable in patients who were previously treated with IL-23 inhibitors. All three agents demonstrated favorable safety profiles, with no serious adverse events or discontinuations. The most frequent adverse events were mild and included upper respiratory tract infections and oral candidiasis. Conclusions: This real-world analysis confirmed that IL-17 inhibitors effectively improved PASI, BSA, and DLQI scores in moderate-to-severe psoriasis. Bimekizumab demonstrated the most rapid early improvements and a higher modeled likelihood of complete clearance, without significant differences at week 12. All agents were well tolerated, underscoring the need for further individualized, large-scale studies.

Keywords: Interleukin Inhibitors; bimekizumab; interleukin-17; ixekizumab; psoriasis; secukinumab.

Figure 1

Reduction in the Psoriasis Area and Severity Index (PASI) following a single dose of bimekizumab, assessed at the one-month follow-up visit during biological therapy.

Figure 2

Reduction in the Psoriasis Area and Severity Index (PASI) following three doses of ixekizumab, assessed at the one-month follow-up visit during biological therapy.

Figure 3

Reduction in the Psoriasis Area and Severity Index (PASI) following five doses of secukinumab, assessed at the one-month follow-up visit during biological therapy.

Figure 4

Efficacy comparison of bimekizumab, ixekizumab, and secukinumab in reducing Psoriasis Area and Severity Index (PASI) scores at the common treatment endpoint of week 12. Analysis was performed using a mixed model analysis of variance (mixed ANOVA).

Figure 5

Trajectory of long-term biologic treatment visualized through a scatter plot of mean Psoriasis Area and Severity Index (PASI) values, with an interpolated exponential function modeling the therapeutic response over time. The intercept of the fitted curve indicates its deviation from the Y-axis and reflects the theoretical PASI100 achievement threshold, providing insight into the expected timing and extent of maximal clinical response.

Figure 6

Longitudinal course of biological therapy visualized by a scatter plot of mean Body Surface Area (BSA) values, with an interpolated exponential function modeling the treatment trajectory. The intercept of the curve reflects its deviation from the Y-axis and corresponds to the theoretical achievement of complete skin clearance (BSA = 0). The exponential interpolation highlights the dynamic reduction in BSA over time during continuous biologic treatment.

Figure 7

Long-term assessment of quality of life in patients receiving IL-17 inhibitor therapy, illustrated by a scatter plot of mean Dermatology Life Quality Index (DLQI) scores and an interpolated exponential function modeling the full treatment trajectory. The function’s intercept indicates the curve’s deviation from the Y-axis, corresponding to the ideal outcome of DLQI = 0.

Figure 8

Relationship between PASI scores at the time of first and second bimekizumab administration, with subgroup analysis based on prior IL-23 inhibitor exposure. Patients with higher baseline PASI values demonstrated a more rapid response to bimekizumab, whereas those with lower initial scores showed a more gradual decline.

Figure 9

Relationship between BSA scores at the time of first and second bimekizumab administration, with subgroup analysis based on prior IL-23 inhibitor exposure.