The IL-23/IL-17A axis in spondyloarthritis: therapeutics informing pathogenesis?

Siebert, S. , McGucken, A. and McInnes, I. B. (2020) The IL-23/IL-17A axis in spondyloarthritis: therapeutics informing pathogenesis? Current Opinion in Rheumatology, 32(4), pp. 349-356. (doi: 10.1097/BOR.0000000000000719) (PMID:32412997)

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Abstract

Purpose of review: To give an overview of the recently published trials relating to IL-23/IL-17 pathway in spondyloarthritis (SpA). Recent findings: Recent studies in psoriasis confirmed the efficacy of targeting the IL-23/IL-17 pathway, with emerging evidence from head-to-head studies suggesting functional hierarchy of these inhibitors. In psoriatic arthritis (PsA), recent studies have indicated the efficacy of inhibiting IL-23p19, in addition to IL-23p40 and IL-17A, albeit all with lower hurdle results than those seen in psoriasis. The first head-to-head study of an IL-17A and tumour necrosis factor inhibitor in PsA has also recently been published. Recent studies have demonstrated the efficacy of the IL-17A inhibitor, ixekizumab, across the axial SpA spectrum. In contrast, inhibition of IL-12/IL-23p40 and IL-23p19 both failed in axial SpA. In inflammatory bowel disease (IBD), recent studies indicate efficacy of IL-23p40 and IL-23p19 inhibition, in contrast to the previous failed studies of IL-17 inhibition. Summary: Clinical trials of IL-23/IL-17 inhibition have been transformative in psoriasis, with more mixed results in PsA and differential responses in axial SpA and IBD. These results pose challenges to our fundamental understanding of SpA pathogenesis and further head-to-head studies and more subtle evaluation of the local tissue-specific aspects will be required.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McInnes, Professor Iain and McGucken, Dr Andrew and Siebert, Professor Stefan
Authors: Siebert, S., McGucken, A., and McInnes, I. B.
College/School:College of Medical Veterinary and Life Sciences > School of Infection & Immunity
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Research Centre:College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
Journal Name:Current Opinion in Rheumatology
Publisher:Lippincott, Williams & Wilkins
ISSN:1040-8711
ISSN (Online):1531-6963

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