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Interleukin 23 Inhibitor

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Interleukin 23 Inhibitor, IL-23 Monclonal Antibody, IL23 Inhibitor, Interleukin-23, IL-23, Guselkumab, Tremfya, Risankizumab, Skyrizi, Tildrakizumab, Ilumya

  • See Also
  1. Interleukin 17 Inhibitor
  2. Interleukin
  3. Psoriasis
  4. Crohn's Disease
  • Indications
  • FDA Approved
  1. Plaque Psoriasis (moderate to severe, candidates for systemic therapy or Phototherapy)
    1. Guselkumab (Tremfya)
    2. Risankizumab (Skyrizi)
    3. Tildrakizumab (Ilumya)
  2. Active Psoriatic Arthritis
    1. Guselkumab (Tremfya)
    2. Risankizumab (Skyrizi)
  3. Crohn's Disease (adults with moderate to severe active disease)
    1. Risankizumab (Skyrizi)
  • Mechanism
  1. Interleukin 23 Inhibitor (IL23 Inhibitor)
    1. The Cytokines IL-23 and IL-17 are released from activated myeloid Dendritic Cells and Macrophages
    2. Cytokines (e.g. IL-23) trigger a proinflammatory cascade, activating immune cells (e.g. T cells)
      1. Angiogenesis
      2. Keratinocyte proliferation
      3. Immune cells migrate to within psoriatic lesions
  2. IL23 Monoclonal antibodies
    1. Self-injectable agents that target IL23
    2. Suppress IL23-triggered inflammatory response
  • Medications
  1. Guselkumab (Tremfya)
    1. Plaque Psoriasis or Psoriatic Arthritis (Adults): 100 mg SQ at Week 0, Week 4 and then every 8 weeks
  2. Risankizumab (Skyrizi)
    1. Plaque Psoriasis or Psoriatic Arthritis (Adults): 150 mg SQ at Week 0, Week 4, then every 12 weeks
    2. Crohn's Disease (Adults)
      1. IV Induction Start: 600 mg IV infusion over 1 hour at week 0, week 4 and week 8
      2. SQ Maintenance (follows IV course): 180 mg or 360 mg SQ at week 12, then every 8 weeks
      3. Monitor for hepatotoxicity at least during IV induction course at baseline and periodically in first 12 weeks
  3. Tildrakizumab (Ilumya)
    1. Plaque Psoriasis (Adults): 100 mg SQ at Week 0 and Week 4, and then every 12 weeks
  • Adverse Effects
  1. Serious
    1. Hypersensitivity Reaction (including Anaphylaxis)
    2. Serious Infections
    3. Tuberculosis activation
      1. Test for Tuberculosis before initiating agents
  2. Common
    1. Infections (URI, UTI, dermatophyte fungal infections, HSV)
    2. Headache
    3. Arthralgias
    4. Gastroenteritis (including Diarrhea)
  • Safety
  1. Unknown safety in pregnancy
  2. Unknown safety in Lactation
  • Drug Interactions
  1. Live Vaccines
    1. Avoid concurrently with IL-23 inhibitors
  • Resources
  1. Guselkumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6dc9ae-1c4c-42d9-87aa-c315ecc51b56
  2. Risankizumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7148c8eb-b39e-e20a-6494-a6df82392858
  3. Tildrakizumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c6a322bb-51b9-4f0e-8642-62a9682ffcde