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Novel Biologics that Inhibit the Th17 Pathway in Psoriatic Disease
Dr. Vinod Chandran
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June 10 2016 8:08 PM ET — via RheumReports 
Over the last 2 years, the safety and efficacy of monoclonal antibodies to IL-17A has been demonstrated and secukinumab is now available for the treatment of psoriasis and PsA in Canada. Newer molecules that target this pathway are in development and a few studies were reported at EULAR give us a window to the future of therapies for psoriatic disease.
Dr. Baeten (#OP0108) presented the results of a Phase 1b dose-ranging study with bimekizumab in PsA. Bimekizumab is a monoclonal antibody inhibiting the activity of both IL-17A and IL-17F, two key and closely related Th17 signature cytokines. At week 8, the ACR20/50 responses for bimekizumab were 80/40 and for PBO 17/8%, respectively. The PASI90 responses were 87% and 0%, respectively. Thus this novel IL17A/F blocker seems to provide rapid and effective relief in patients with active PsA.
IL23 is another important cytokine of the Th17 pathway. Tildrakizumab is an anti‐IL‐23p19 monoclonal antibody, and thus targets IL-23 specifically, as opposed to the anti-IL23p40 antibody, ustekinumab, that targets both IL-23 and IL-12. Tildrakizumab has been shown to be efficacious for the treatment of moderate-to-severe plaque psoriasis in a Phase 2 study. A small proportion of patients in this study had a history of PsA (65/355).
In a post hoc subgroup analysis of those with a history of PsA reported today (#FRI0445), numerically greater responses were observed in patients receiving tildrakizumab for pain and PASE scores (a questionnaire that is used for screening as well as assessing the degree of functional limitation due to PsA).
Thus, tildrakizumab may have efficacy in PsA and results for formal trials in PsA are eagerly awaited.
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About the Author
Dr. Vinod Chandran
Dr. Chandran is a rheumatologist and clinician-scientist, an Assistant Professor of Medicine & Laboratory Medicine and Pathobiology at the University of Toronto, an affiliate scientist at the Krembil Research Institute, a staff physician at the University Health Network and Mount Sinai Hospitals, and an associate member of the graduate faculty at the Institute of Medical Science. He co-directs the Psoriatic Arthritis Program at the University Health Network.
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