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IL-23 Inhibitors: How They Treat Psoriasis and Psoriatic Arthritis
Introduction: Key Points on IL-23 Inhibitors
Interleukin-23 (IL-23) inhibitors are a class of medications used to treat inflammatory conditions such as psoriasis and psoriatic arthritis. These drugs target a specific protein in the immune system, IL-23, which plays a crucial role in driving inflammation. By inhibiting IL-23, these medications help alleviate symptoms like skin plaques and joint pain. They are often favored over other treatments due to their effectiveness and generally well-tolerated nature.
Medications within the IL-23 Inhibitor Class
Common IL-23 inhibitors include:
- Ilumya (tildrakizumab-asmn)
- Skyrizi (risankizumab-rzaa)
- Tremfya (guselkumab)
The generic name, listed in parentheses, refers to the drug’s active ingredient.
How Do IL-23 Inhibitors Work? Mechanism of Action
IL-23 inhibitors work by blocking the activity of the IL-23 protein, which is involved in the immune response. IL-23 plays a pivotal role in triggering inflammation, leading to conditions like psoriasis and psoriatic arthritis. By inhibiting IL-23, these medications help regulate the overactive immune response, reducing inflammation and improving symptoms. While all IL-23 inhibitors target the same protein, they may bind to different parts of it. However, the overall effect remains consistent—dampening inflammation.
Benefits of IL-23 Inhibitor Treatment
IL-23 inhibitors are prescribed for moderate to severe psoriasis and psoriatic arthritis, particularly in patients who have not responded well to other treatments. These medications are often preferred because they specifically target IL-23, a key player in the inflammatory process. This targeted approach can lead to fewer side effects compared to older treatments like methotrexate or TNF inhibitors. Additionally, IL-23 inhibitors are known for their long-lasting effects, meaning patients may require fewer doses over time. If you think IL-23 inhibitors might be a suitable option for you, consult one of our healthcare providers through telemedicine to explore your treatment options.
Potential Side Effects of IL-23 Inhibitors
Like all medications, IL-23 inhibitors can cause side effects. It’s important to be aware of both common and rare side effects to make an informed decision about your treatment. Always consult your healthcare provider before starting any new medication, especially if you have underlying health conditions or are taking other medications.
Common Side Effects of IL-23 Inhibitors
The most common side effects of IL-23 inhibitors occur in more than 1% of patients. These side effects are generally mild to moderate and may improve over time as your body adjusts to the medication. However, if any of these side effects persist or worsen, contact your healthcare provider.
- Upper respiratory infections (13-14%): Symptoms may include sore throat, cough, and nasal congestion. Patients with a history of frequent respiratory infections may be at higher risk.
- Headache (4-5%): Some patients report mild to moderate headaches. Staying hydrated and resting may help alleviate this symptom.
- Fatigue (3-4%): Feeling unusually tired or lacking energy is common. This may be more pronounced in patients with other chronic conditions.
- Injection site reactions (2-3%): Redness, swelling, or discomfort at the injection site can occur. These reactions are usually mild and resolve within a few days.
- Joint pain (arthralgia) (1-2%): Some patients may experience mild joint discomfort, particularly in the hands, knees, or other joints.
Less Common Side Effects
These side effects occur in less than 1% of patients but are still important to be aware of. If you experience any of these, contact your healthcare provider:
- Allergic reactions
- Fungal infections
- Gastrointestinal symptoms (nausea, diarrhea)
- Skin rashes
- Changes in mood or depression
Severe Side Effects of IL-23 Inhibitors
Though rare, some patients may experience severe side effects. If you notice any of the following, seek medical attention immediately:
- Serious infections: IL-23 inhibitors can weaken your immune system, making it harder to fight infections. Symptoms of a serious infection include fever, chills, persistent cough, or shortness of breath.
- Severe allergic reactions: Signs include difficulty breathing, swelling of the face or throat, and hives. This is a medical emergency and requires immediate attention.
Patients with a history of recurrent infections, chronic lung disease, or compromised immune systems may be at higher risk for these severe side effects. Always discuss your full medical history with your healthcare provider before starting IL-23 inhibitors.
Drug to Drug Interactions with IL-23 Inhibitors
Drug interactions can occur when IL-23 inhibitors are taken alongside other medications, potentially affecting their efficacy or increasing the risk of side effects. It’s important to review all medications you are taking, including over-the-counter drugs and supplements, with your healthcare provider.
Immunosuppressants: Using IL-23 inhibitors in combination with other immunosuppressive medications (e.g., methotrexate, cyclosporine) may increase the risk of infections.
Live vaccines: IL-23 inhibitors can reduce the effectiveness of live vaccines (e.g., MMR, chickenpox) and may increase the likelihood of contracting the infection the vaccine is designed to prevent. It is generally recommended to avoid live vaccines while undergoing IL-23 inhibitor treatment.
Biologic therapies: Combining IL-23 inhibitors with other biologic therapies (e.g., TNF inhibitors, IL-17 inhibitors) may elevate the risk of serious side effects, including infections and immune system complications.
Precautions and Contraindications for IL-23 Inhibitors
Before starting treatment with IL-23 inhibitors, it’s essential to discuss any underlying health conditions or concerns with your healthcare provider. Certain conditions may require special precautions or may contraindicate the use of IL-23 inhibitors.
Precautions When Using IL-23 Inhibitors
Infections: Since IL-23 inhibitors suppress the immune system, individuals with a history of chronic or recurrent infections should use this medication with caution. Your healthcare provider may recommend additional monitoring or preventive measures to reduce the risk of infection.
Tuberculosis (TB): Patients should be screened for TB before starting IL-23 inhibitors. If you have latent TB, treatment may be necessary before beginning the medication to prevent reactivation of the infection.
Hepatitis B or C: If you have a history of hepatitis B or C, your healthcare provider will closely monitor your liver function, as IL-23 inhibitors can potentially reactivate these infections.
Pregnancy and breastfeeding: There is limited information on the safety of IL-23 inhibitors during pregnancy and breastfeeding. If you are pregnant, planning to become pregnant, or breastfeeding, it’s important to discuss the potential risks and benefits with your healthcare provider.
Contraindications for IL-23 Inhibitors
Severe allergic reactions: If you have experienced a severe allergic reaction to IL-23 inhibitors or any of their components, you should not use this medication.
Active infections: Patients with active infections, including untreated tuberculosis or hepatitis, should not begin treatment with IL-23 inhibitors until the infection has been fully treated.
Conclusion: Understanding IL-23 Inhibitors
Interleukin-23 (IL-23) inhibitors offer an effective treatment option for autoimmune conditions such as psoriasis and Crohn’s disease. While these medications can significantly improve symptoms, it’s important to be mindful of potential side effects, drug interactions, and necessary precautions. Always consult your healthcare provider before starting any new medication, especially if you have underlying health conditions or are taking other medications.
If you have questions about IL-23 inhibitors or would like to explore your treatment options, our telemedicine providers are available to assist you. Schedule a virtual appointment today to speak with a healthcare professional from the comfort of your home.
