Anti-IL-23 Biologic Therapy: Expanding our Knowledge and Access for Patients with Psoriasis

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, for a discussion of the IL-23 pathway and its enduring role in psoriasis management. Although therapeutic options continue to expand, IL-23 remains a central target because of its key role in the IL-23/Th17 axis, one of the primary drivers of psoriatic disease.

Dr Song reviews the current IL-23 therapeutic landscape, comparing available agents that target the pathway through different mechanisms. He highlights important distinctions among therapies, including dosing intervals, molecular characteristics, binding affinity, and immunogenicity, while emphasizing that all have demonstrated strong efficacy and favorable safety profiles. The conversation also explores how these pharmacologic differences do—and do not—translate into meaningful clinical differences.

The conversation also explores patient access, with Drs Del Rosso and Song discussing how route of administration and insurance coverage can significantly influence treatment selection, particularly for Medicare beneficiaries. They examine the practical advantages of health care provider-administered therapy, including more reliable treatment delivery, closer patient follow-up, and reduced financial barriers for some patients.

The discussion also addresses expectations for treatment response, emphasizing that IL-23 inhibitors may require more time than other biologic classes to achieve maximal benefit. Dr Song shares practical insights into assessing early improvement, counseling slower responders, and supporting long-term treatment persistence.

The episode concludes with a review of the safety profile of IL-23 inhibitors, including their role in psoriasis with peripheral psoriatic arthritis, while discussing areas where these therapies remain more limited, such as axial disease and uveitis.

Tune in to the full episode to learn more about the IL-23 pathway, the similarities and distinctions among available therapies, practical access considerations, and setting realistic expectations for treatment response in everyday psoriasis care.