Biologic therapies targeting the interleukin (IL)-23/IL-17 immune axis for the treatment of moderate-to-severe plaque psoriasis: a systematic review and meta-analysis.

There are a rapidly increasing number of novel biologic therapies for psoriasis targeting interleukin-23 (IL-23) and interleukin-17 (IL-17). This systematic review and meta-analysis evaluated the efficacy and safety of induction therapy (12-16 weeks) with biologic therapies targeting the IL-23/IL-17 immune axis for the treatment of moderate-to-severe plaque psoriasis. Twenty-seven randomized controlled trials met the specified inclusion criteria. The results showed that ixekizumab q2w had the greatest efficacy in terms of achieving 90% reduction in Psoriasis Area and Severity Index when compared to placebo [risk ratio (RR): 65.01, 95% confidence intervals (CI): 13.97-302.56, P < 0.00001], etanercept (RR: 3.14, 95% CI: 2.22-4.45) and ustekinumab (RR: 1.73, 95% CI: 1.41-2.12). The IL-17 inhibitors were overall shown to have a higher efficacy than the IL-23 inhibitors during induction therapy. However, the IL-17 inhibitors had an increased risk of adverse events when compared to placebo, while there was no increased risk with any of the IL-23 inhibitors. In conclusion, induction therapy with IL-17 inhibitors is highly efficacious but carries a higher risk of adverse events than induction therapy with IL-23 inhibitors.