A RECENT clinical trial has compared the effectiveness of IL-17 and IL-23 biologics in treating moderate to severe plaque psoriasis, particularly in patients with coexisting metabolic syndrome (MetS). The study involved 120 participants – 60 with MetS and 60 without – randomly assigned to receive IL-17 biologics, IL-23 biologics, or cyclosporine over a three-month treatment period.
Clinical efficacy was evaluated using the Psoriasis Area and Severity Index (PASI), along with metabolic indicators such as fasting glucose, triglycerides, HDL-C, and inflammatory markers including CRP and IL-6. Both IL-17 and IL-23 biologics outperformed cyclosporine, achieving significantly lower PASI scores and marked improvements in metabolic parameters by the end of the trial (P < 0.05).
While IL-17 biologics provided a faster initial response, IL-23 biologics demonstrated superior long-term outcomes, particularly at the three-month point. Notably, IL-23 treatment yielded better reductions in fasting glucose, triglycerides, and CRP levels. Furthermore, IL-23 biologics were less affected by the presence of metabolic syndrome, maintaining stronger efficacy in patients with metabolic abnormalities.
Although both biologic treatments showed promising improvements in skin lesions and metabolic profiles, the presence of MetS somewhat reduced the overall effectiveness – especially for IL-17 biologics. The IL-23 group, however, retained better treatment outcomes regardless of metabolic status.
In summary, IL-23 biologics offer not only effective psoriasis management but also broader metabolic benefits, making them the preferred option for long-term treatment, especially in patients with metabolic syndrome. This study supports the growing emphasis on personalised treatment strategies that consider comorbid conditions such as MetS in chronic inflammatory diseases like psoriasis.
Reference
Jiang W et al. The impact of biologics targeting the IL-17 and IL-23 pathways on metabolic indicators in plaque psoriasis. Arch Dermatol Res. 2025;317(1):643.
