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. 2025 Sep 8:14:2025-5-1.
doi: 10.7573/dic.2025-5-1. eCollection 2025.

Real-world analysis of IL-23 inhibitors in patients with moderate-to-severe psoriasis and early musculoskeletal symptoms

Annunziata Dattola  1 , Nicoletta Bernardini  2 , Jasmine Anedda  3 , Laura Atzori  3 , Claudio Bonifati  4 , Pier Luigi Bruni  5 , Domenico Giordano  6 , Dario Graceffa  4 , Elisa Molinelli  7 , Gaia Moretta  8 , Cristina Mugheddu  3 , Annamaria Offidani  7 , Gianluca Pagnanelli  8 , Sabatino Pallotta  8 , Manuela Papini  9 , Severino Persechino  6 , Antonio Giovanni Richetta  1 , Ersilia Tolino  2 , Federica Trovato  8 , Giovanni Pellacani  1 , Concetta Potenza  2
Affiliations

Real-world analysis of IL-23 inhibitors in patients with moderate-to-severe psoriasis and early musculoskeletal symptoms

Annunziata Dattola et al. Drugs Context. .

Abstract

Background: Psoriasis is a chronic inflammatory condition that may develop into psoriatic arthritis (PsA) in a significant number of patients. Clinical signs such as enthesitis and nail involvement have been suggested as early indicators of this progression. IL-23 inhibitors have demonstrated effectiveness in psoriasis and, more recently, in PsA. This article aims to evaluate the effect of IL-23 inhibitors on clinical outcomes and progression of PsA in patients with moderate-to-severe psoriasis and early musculoskeletal involvement.

Methods: This was a retrospective, multicentre observational study conducted in Italy. Data were collected from 207 adult patients who had already started treatment with guselkumab, risankizumab or tildrakizumab prior to inclusion. All clinical data, including baseline characteristics and follow-up outcomes, were retrieved retrospectively from medical records across eight dermatology centres.

Results: Enthesitis was observed in 44.8% of patients with joint involvement. Guselkumab was the most commonly used treatment (57%) and demonstrated sustained improvements in Psoriasis Area and Severity Index, Visual Analogue Scale pain and Dermatology Life Quality Index scores. Importantly, no patients with enthesitis treated with guselkumab progressed to overt PsA. At 52 weeks, the average Psoriasis Area and Severity Index score was 0.61, Visual Analogue Scale pain score was 0.59 and Dermatology Life Quality Index score was 0.91.

Conclusion: IL-23 inhibitors have proven effective in managing both skin and joint symptoms in patients with psoriasis at risk for PsA. Whilst the findings suggest that IL-23 inhibitors may help control early musculoskeletal symptoms in patients with psoriasis at risk of PsA, the absence of systematic rheumatological evaluation and the retrospective design preclude definitive conclusions about their disease-modifying potential. These results suggest a potential disease-modifying role that warrants further prospective validation.

Keywords: IL-23; guselkumab; psoriasis; psoriatic arthritis.

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Conflict of interest statement

Disclosure and potential conflicts of interest: AD has served as a speaker, consultant, or advisory board member for Abbvie, Almirall, Amgen, Eli Lilly, Leo Pharma, Janssen, Novartis, Boehringer Ingelheim and UCB Pharma outside the submitted work. D Giordano received Payment, honoraria or support from Abbvie, Almirall, Amgen, Eli Lilly, Fresenius Kabi, Janssen-Cilag, Novartis, Sanofi, Pfizer and Difa-Cooper. GM received payment, honoraria or support from Abbvie, Leopharma, Sanofi and Lilly. AO received payment, honoraria or support from Abbvie, Novartis, Sanofi, Eli Lilly and UCB Pharma. JA, NB, LA, CB, PLB, EM, CM, G Pangnanelli, S Pallotta, MP, S Persechino, G Pellacani, CP, AGR and ET declare no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2025/09/dic.2025-5-1-COI.pdf

Figures

Figure 1
Figure 1
Psoriasis Area and Severity Index (PASI) reduction over time by treatment group. Mean PASI scores at baseline (T0), week 4 (T4), week 8 (T8) and week 12 (T12) for patients treated with guselkumab (GUS), risankizumab (RIS) or tildrakizumab (TIL). PASI is scored on a 0–72 scale. Values are means ± SD. Sample sizes per group: GUS (n=117), RIS (n=61), TIL (n=29).
Figure 2
Figure 2
Super-responders (Psoriasis Area and Severity Index (PASI) 0 at week 4) by treatment. Number of patients achieving PASI 0 at week 4 (T4) stratified by treatment. PASI 0 is defined as complete skin clearance. Super-responders were those achieving PASI 0 starting from a baseline PASI of ≥10. Total super responder group: n=43.
See this image and copyright information in PMC

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