Investigational interleukin 17A antagonists in the treatment of psoriatic arthritis

INTRODUCTION: The global burden of psoriatic arthritis (PsA) is considerable, with major effects on both quality of life and life expectancy. Despite the existence of a diverse array of therapeutic interventions, approximately 40-50% of patients do not achieve the established therapeutic targets. Challenges related to tolerance, compliance, and therapeutic escape persist. AREAS COVERED: This study is a comprehensive review of the current literature analyzing the central role of interleukin-17 (IL-17) in the pathogenesis of PsA and emphasizing current and investigational therapies for IL-17A blockade. A structured search was conducted in PubMed for the following terms investigational IL-17A antagonist and Psoriatic arthritis. We aimed for at least 100 research papers published within the last 20 years. In addition, clinical trials databases focusing on phase II - III IL-17A antagonists treatment in Psoriatic Arthritis were also reviewed. EXPERT OPINION: The current stage of development and expansion of IL-17A antagonists encompasses the third generation of such molecules. This generation includes small, injectable molecules such as sonelokimab and izokibep; oral molecules; and bispecific monoclonal antibodies. This approach is purported to facilitate enhanced tissue diffusion, augmented efficacy in refractory forms, and simplified utilization. The future of PsA treatments is contingent upon the implementation of precision medicine, which leverages predictive biomarkers to personalize treatment from the moment of diagnosis. This could help control disease early and prevent progression, beyond the current Treat-to-Target strategy which mainly focuses on managing existing symptoms. The overarching objective is no longer to treat to target, but rather to treat to intercept, while ensuring the highest rate of control and tolerance for the patient.