II. Indications: FDA Approved

  1. Plaque Psoriasis (moderate to severe, candidates for systemic therapy or Phototherapy)
    1. Guselkumab (Tremfya)
    2. Risankizumab (Skyrizi)
    3. Tildrakizumab (Ilumya)
  2. Active Psoriatic Arthritis
    1. Guselkumab (Tremfya)
    2. Risankizumab (Skyrizi)
  3. Crohn's Disease (adults with moderate to severe active disease)
    1. Risankizumab (Skyrizi)

III. Mechanism

  1. Interleukin 23 Inhibitor (IL23 Inhibitor)
    1. The Cytokines IL-23 and IL-17 are released from activated myeloid Dendritic Cells and Macrophages
    2. Cytokines (e.g. IL-23) trigger a proinflammatory cascade, activating immune cells (e.g. T cells)
      1. Angiogenesis
      2. Keratinocyte proliferation
      3. Immune cells migrate to within psoriatic lesions
  2. IL23 Monoclonal antibodies
    1. Self-injectable agents that target IL23
    2. Suppress IL23-triggered inflammatory response

IV. Medications

  1. Guselkumab (Tremfya)
    1. Plaque Psoriasis or Psoriatic Arthritis (Adults): 100 mg SQ at Week 0, Week 4 and then every 8 weeks
  2. Risankizumab (Skyrizi)
    1. Plaque Psoriasis or Psoriatic Arthritis (Adults): 150 mg SQ at Week 0, Week 4, then every 12 weeks
    2. Crohn's Disease (Adults)
      1. IV Induction Start: 600 mg IV infusion over 1 hour at week 0, week 4 and week 8
      2. SQ Maintenance (follows IV course): 180 mg or 360 mg SQ at week 12, then every 8 weeks
      3. Monitor for hepatotoxicity at least during IV induction course at baseline and periodically in first 12 weeks
  3. Tildrakizumab (Ilumya)
    1. Plaque Psoriasis (Adults): 100 mg SQ at Week 0 and Week 4, and then every 12 weeks

V. Adverse Effects

  1. Serious
    1. Hypersensitivity Reaction (including Anaphylaxis)
    2. Serious Infections
    3. Tuberculosis activation
      1. Test for Tuberculosis before initiating agents
  2. Common
    1. Infections (URI, UTI, dermatophyte fungal infections, HSV)
    2. Headache
    3. Arthralgias
    4. Gastroenteritis (including Diarrhea)

VI. Safety

  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation

VII. Drug Interactions

  1. Live Vaccines
    1. Avoid concurrently with IL-23 inhibitors

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

tremfya (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TREMFYA 100 MG/ML INJECTOR $12,239.52 per ml
skyrizi (on 7/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SKYRIZI 150 MG/ML PEN $17,642.38 per ml
SKYRIZI 150 MG/ML SYRINGE $17,835.55 per ml

Ontology: interleukin-23 (C0963088)

Definition (MSH) A heterodimeric cytokine that plays a role in innate and adaptive immune responses. Interleukin-23 is comprised of a unique 19 kDa subunit and 40 kDa subunit that is shared with INTERLEUKIN-12. It is produced by DENDRITIC CELLS; MACROPHAGES and a variety of other immune cells
Concepts Biologically Active Substance (T123) , Amino Acid, Peptide, or Protein (T116)
MSH D053759
English IL-23, Interleukin 23, Interleukin-23, INTERLEUKIN 023, IL 023, Interleukin-23 [Chemical/Ingredient], interleukin-23
Portuguese Interleucina-23, IL-23
Spanish Interleucina-23, IL-23
Russian IL-23, ИНТЕРЛЕЙКИН-23, INTERLEIKIN-23
Italian Interleuchina-23
German Interleukin-23, IL-23
French IL-23, IL23, Interleukine-23
Finnish Interleukiini-23
Czech IL-23, interleukin-23
Japanese インターロイキン23, インターロイキン-23
Swedish Interleukin-23
Croatian INTERLEUKIN-23
Polish Interleukina 23

Ontology: guselkumab (C3852217)

Concepts Amino Acid, Peptide, or Protein (T116) , Biologically Active Substance (T123)
MSH C000588857
English guselkumab