The utility of IL-23 intraclass switching in the treatment of plaque psoriasis: a retrospective review of 43 cases.

IL-23 inhibitors are a class of injectable biologics consisting of risankizumab, tildrakizumab, and guselkumab utilized for treatment of moderate-to-severe psoriasis. This retrospective review sought to determine the value of IL-23 inhibitor intraclass switching among psoriasis patients after experiencing loss of efficacy to any IL-23 inhibitor. We conducted a retrospective chart review, including 43 patients who underwent any of six potential iterations of IL-23 intraclass switch between 11/2017-11/2023. Most commonly, patients switched from guselkumab or tildrakizumab to risankizumab (83.7%). Patients failed 2.3 ± 1.3 biologic treatments prior to switch. Post-switching, 81.4% of patients achieved BSA <1% after 248.8 ± 126.5 days. BSA immediately prior to intraclass switch was 13.1 ± 8.9 [95% CI: 10.4, 15.8] and at most recent follow-up was 2.9 ± 5.2 [2.3, 5.5]. This research adds to a growing body of literature demonstrating the potential of IL-23 intraclass switching in treatment of moderate-to-severe plaque psoriasis.