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

Abstract Interleukin (IL)-23 inhibitors are a class of injectable biologics, which include risankizumab, tildrakizumab and guselkumab, used for the treatment of moderate-to-severe psoriasis. This retrospective review sought to determine the value of IL-23 inhibitor intraclass switching among patients with psoriasis after they experienced loss of efficacy to any IL-23 inhibitor. We conducted a retrospective chart review, including 43 patients who underwent any of 6 potential iterations of IL-23 intraclass switching between November 2017 and November 2023. Most commonly, patients switched from guselkumab or tildrakizumab to risankizumab (84%). On average, patients failed 2.3 biologic treatments (SD 1.3) prior to switching. Postswitching, 81% of patients achieved an affected body surface area (BSA) < 1% after 248.8 days (SD 126.5). BSA immediately prior to intraclass switch was 13.1 (SD 8.9) [95% confidence interval (CI) 10.4–15.8] and at most recent follow-up was 2.9 (SD 5.2) (95% CI 2.3–5.5). This research adds to a growing body of literature demonstrating the potential of IL-23 intraclass switching in the treatment of moderate-to-severe plaque psoriasis.