EFFICACY AND SAFETY OF IL-23 INHIBITORS IN PSORIATIC ARTHRITIS: A LITERATURE REVIEW
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5635Keywords:
Psoriatic Arthritis, IL-23 Inhibitors, Guselkumab, Risankizumab, TildrakizumabAbstract
Introduction: Psoriatic arthritis (PsA) is a chronic, heterogeneous immune-mediated inflammatory disease affecting multiple clinical domains, including peripheral arthritis, skin lesions, enthesitis, and dactylitis. Given the key role of the IL-23/IL-17 axis in PsA pathogenesis, IL-23 inhibitors have emerged as an important therapeutic option.
Methodology: A structured literature search of the PubMed database was performed to identify studies evaluating the efficacy and safety of IL-23 inhibitors in PsA. The available evidence was based mainly on randomized trials of guselkumab, risankizumab, and tildrakizumab. Phase III randomized controlled trials were prioritized, while relevant meta-analyses, network meta-analyses, systematic reviews, and selected post hoc or pooled analyses were included to complement the assessment of multidomain outcomes, structural progression, and safety.
Results: IL-23 inhibitors showed significant efficacy in peripheral arthritis and provided clinically meaningful benefits in other important disease domains, including skin lesions, physical function, minimal disease activity, enthesitis, and dactylitis. The most robust evidence supported guselkumab and risankizumab, whereas the evidence base for tildrakizumab remained more limited. Guselkumab also showed the clearest evidence for inhibition of structural progression. Across studies, IL-23 inhibitors demonstrated a generally favorable and stable safety profile, with infections being the most commonly reported adverse events and no clear emerging long-term safety concerns.
Conclusions: IL-23 inhibitors represent an effective and clinically relevant therapeutic strategy in PsA, with benefits across multiple disease domains and a generally favorable safety profile. Current evidence most strongly supports guselkumab and risankizumab, while further data are needed to better define the role of tildrakizumab.
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Copyright (c) 2026 Julia Marek, Aleksandra Wiśniewska, Karolina Kasprzak , Małgorzata Kuczek, Zuzanna Rabczak, Justyna Tasior
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