IL-17 inhibitors have demonstrated both efficacy and a favorable safety profile, and they may offer versatility in managing psoriasis. Understanding their potential role in treatment and targeting their use to appropriate patient populations may help optimize care.

IL-17 inhibitors have a number of advantages that can make them attractive for certain patients with psoriasis. First, they have a very rapid onset. For a patient who has psoriasis over a large body surface area, or on body sites that significantly impact daily life, the treatment priority is to clear them as quickly as possible. In those cases, IL-17 inhibitors can be helpful.

IL-17 inhibitors can also be a good choice for the treatment of psoriasis in difficult-to-treat areas, including the palms, soles, scalp, genitals, and nails. There are many different psoriasis manifestations on the nails, including nail pitting and onycholysis. These manifestations can be painful and can make it difficult for a patient to use their hands, which can impact their ability to work, care for their children, or even bathe themselves. It is important to find an effective treatment, and IL-17 inhibitors have strong data for being very effective for nail psoriasis. The presence of nail psoriasis is also a risk factor for developing psoriatic arthritis. Multiple biologics have approval from the US Food and Drug Administration (FDA) for both psoriasis and psoriatic arthritis, but IL-17 inhibitors are among the most effective for both skin and joint disease.

A number of comorbid conditions can have an impact on the treatment that we select for a patient with psoriasis. IL-17 inhibitors can be a good choice for several comorbidities. For example, they can be considered for patients with multiple sclerosis and for those with a history of malignancy. Additionally, IL-17 inhibitors have been shown to have a favorable safety profile in patients with chronic infections such as hepatitis B, hepatitis C, and HIV, although it is important to prioritize control of the infection in such individuals.

IL-17 inhibitors are generally considered contraindicated in inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. Some clinical trials of IL-17 inhibitors for psoriasis included individuals who either had worsening of known IBD or developed new IBD while on treatment. There is controversy regarding how strong that effect may be, but the signal does exist. If a patient on IL-17 inhibitor therapy starts to develop signs or symptoms of IBD, workup is warranted.

Overall, IL-17 inhibitors are quite safe, but there are a few adverse events associated with their use to be aware of. Because IL-17 is part of the innate immune response to Candida infection, people treated with IL-17 inhibitors can develop thrush or candidiasis. This is generally manageable with topical or oral medications. In addition, as with all biologics, IL-17 inhibitors are immunosuppressive. So, patients on IL-17 inhibitor therapy might get upper respiratory infections, for example, more often than they would if they were not on these medications. Finally, injection site reactions can occur with the use of IL-17 inhibitors. These are typically not dangerous, but they can sometimes be very bothersome to a patient and can interfere with their willingness to continue treatment.