IL-17 Inhibition vs IL-23 Inhibition for Psoriatic Arthritis: An Ongoing Debate
Bibliographic record
Abstract
The interleukin-17 (IL-17) and interleukin-23 (IL-23) pathways play a central role in the pathogenesis of psoriatic disease (PsD). This review outlines the immunobiology of these cytokine pathways and summarizes the current evidence on the efficacy and safety of IL-17 and IL-23 inhibitors across PsD domains, including peripheral arthritis, axial arthritis, enthesitis, dactylitis, psoriasis, and inflammatory bowel disease (IBD). IL-17 inhibitors, which target the effector cytokines IL-17A, IL-17F, or their receptors, have demonstrated robust efficacy in psoriasis, peripheral arthritis, and axial disease. IL-23 inhibitors act upstream by targeting the p19 subunit of IL-23 and show comparable efficacy in peripheral arthritis and psoriasis, though evidence for efficacy in axial disease remains limited. While IL-17 inhibitors carry a risk of IBD exacerbation, IL-23 inhibitors are considered therapeutic options for patients with coexisting IBD. In addition, radiographic progression appears better suppressed by IL-17 inhibitors, although emerging data suggest that IL-23 blockade may offer delayed benefits. Both IL-17 and IL-23 drug classes exhibit favourable safety profiles, with clinical trials suggesting slightly better tolerability for IL-23 inhibitors. Future directions include head-to-head comparisons, biomarker-guided treatment selection, and trials assessing long-term structural outcomes. Understanding the tissue- and cell-specific effects of inhibiting these cytokine pathways is key to optimizing therapy in PsD.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".