The feasibility of the use of monoclonal antibodies to interleukin 23 in the therapy of severe psoriasis with the eluding effect of genetically engineered biological drugs

Abstract

Psoriatic disease is a condition characterised by the development of a progressive chronic inflammatory process caused by various immunological pathways, among which the IL-23/Th17 axis plays a key role. Therefore, the efficacy of IL-23 p19 inhibitors is currently being actively studied. To date, quite a large number of therapeutic options among genetically engineered biological drugs (GEBDs) exist for the treatment of psoriasis, but in real clinical practice patients may lose efficacy or suffer from adverse events, resulting in the need to switch to other classes of GEBDs. Guselkumab is a fully human IgG1λ monoclonal antibody that binds selectively to the p19 subunit of interleukin 23 (IL-23) with high specificity and affinity. The implementation of the drug into clinical practice has improved the efficacy, safety and survival rate of genetically engineered biological therapy for psoriasis. Finding optimal approaches to the treatment of psoriatic disease by analysing data from clinical trials and actual practice is the real challenge for practicing clinicians. However, a current problem is the lack of sufficient information on the use of guselkumab in real clinical practice when it is initiated subsequent to administration of other classes of GEBDs – anti-TNF-α, anti-IL-17 and/or anti-IL-12/23. This article provides a review of the existing literature, as well as our own clinical observations of non-bionaive patients with successful therapy switching to the IL-23 inhibitor guselkumab. Understanding the basic aspects of GEBD therapy for psoriasis will help to achieve successful control of the disease and improve the quality of life of patients in general.