SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Inflammation Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1669786
Clinical Benefits and Complication Profile of IL-23 Inhibitors in Patients with Psoriatic Arthritis: A Systematic Review and Meta-Analysis
Provisionally accepted
Jingxin Zeng1Ling Lin2Wei Li2Xinjing Gao3Qian Li2Xin Zhou2Weiyu Liu2Xuelian Zhong2Yunqing Yang2Xibao Zhang2
Quan Luo4*- 1Guangdong Second Provincial General Hospital, Guangzhou, China
- 2Guangzhou Dermatology Hospital, Guangzhou, China
- 3Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- 4Guangzhou Institute of Dermatology, Guangzhou, China
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Background: Psoriatic arthritis (PsA) is a chronic inflammatory disease with heterogeneous manifestations affecting both joints and skin. Interleukin-23 (IL-23) plays a central role in the Th17-mediated inflammatory pathway implicated in PsA pathogenesis. This meta-analysis aimed to evaluate the clinical efficacy and safety profile of IL-23 inhibitors in the treatment of PsA. Methods: A systematic literature search was conducted across PubMed, Embase, Web of Science, and Cochrane Library up to June 30, 2025, adhering to PRISMA guidelines. Randomized controlled trials (RCTs) involving adult Psoriatic Arthritis (PsA) patients treated with IL-23 inhibitors versus placebo were included. Key outcomes analyzed included American College of Rheumatology (ACR) 20, 50, and 70 responses, Psoriasis Area and Severity Index (PASI) 90, minimal disease activity (MDA), and enthesitis and dactylitis resolution. Results: Six RCTs involving IL-23 inhibitors were included. IL-23 inhibitors significantly improved ACR20 (RR = 1.86; 95% CI: 1.69–2.05), ACR50 (RR = 2.75; 95% CI: 2.31–3.29), and ACR70 (RR = 3.06; 95% CI: 2.29–4.10) responses. Skin clearance (PASI90) was markedly higher (RR = 5.98; 95% CI: 4.68–7.64). IL-23 inhibition also resulted in superior MDA (RR = 2.85; 95% CI: 2.30–3.54), and better resolution of enthesitis (RR = 1.46; 95% CI: 1.29–1.64) and dactylitis (RR = 1.39; 95% CI: 1.20–1.61). Publication bias was not detected. Conclusions: IL-23 inhibitors are effective in improving musculoskeletal and dermatologic outcomes in PsA, supporting their role in comprehensive treatment strategies. Further long-term comparative studies are needed.
Keywords: psoriatic arthritis, IL-23 inhibitors, randomized controlled trials, ACR response, PASI90, minimal disease activity
Received: 20 Jul 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Zeng, Lin, Li, Gao, Li, Zhou, Liu, Zhong, Yang, Zhang and Luo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Quan Luo, quanluo0711@outlook.com
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