‘Efficacy of <scp>anti‐IL</scp>‐23 and <scp>anti‐IL</scp>‐17 after adalimumab failure in psoriatic patients’—response to Yu et al.

We would like to answer the issues raised by Dr. Yu and Cheng-Chun Wei in their letter titled "Regarding Mastorino et al.'s 'Efficacy of anti-IL-23 and anti-IL-17 after adalimumab failure in psoriatic patients'1 as authors of the discussed article.2 About the first point of the letter, concerning the rapidity of action of IL-17 inhibitors compared to IL23 inhibitors and the supposedly higher drug survival of the latter, we agree with the authors regarding the lack of real-life studies on the subject. From our point of view, we have published some papers showing a not different survival among the same biologics class and possibly suggesting a higher survival of IL-23 inhibitors at indirect comparison.3, 4 We can also share preview data on drug survival of the two interleukin inhibitors and TNF alpha inhibitors on a wide retrospective cohort of our psoriasis and psoriatic arthritis patients (1149 patients) that allows us to observe a significantly higher survival for IL23 inhibitors than for the other two drug classes in the patients observed up to 24 months (Figure 1). This is in line with the paper by Torres et al.5 We share with the authors the need for studies aimed at evaluating the prevention of psoriasis-associated comorbidities; in particular, one of our projects for evaluating cardiovascular risk reduction is at an embryonic stage. Regarding the prevention of joint involvement, some studies seem to observe this possibility in patients treated with guselkumab.2 On the other hand, risankizumab and tildrakizumab proved effective in the management of skin involvement in both patients with psoriasis and psoriatic arthritis without significant differences.6 Concerning the need for data on ethnic groups other than Caucasian, we totally agree with the authors' position; however, this necessarily falls within the limits of a real-life study conducted in a university hospital in Northern Italy. This can potentially be associated with lower access to care for not Caucasian population in our country, even if we have to consider that the public national health system in Italy allows any resident in the country to have access to dermatology care. Specifically, in the data available to us out of 1149 patients only 4 patients were from Latin America and only 6 from North African countries, with no population representative of the Asian and Central/South African population. In this regard, we encourage colleagues and researchers working in these countries to share their real-world experiences on response to biological treatments to better correlate clinical response proxies with pathogenetic observations on the different Th17/Th23 axis responses. We share with colleagues from Taiwan the need for further studies with large sample sizes in different ethnic groups are needed to foster holistic care for psoriasis and its comorbidities. None. Luca Mastorino, Michela Ortoncelli, Paolo Dapavo, Pietro Quaglino, Simone Ribero have no conflict of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Topic: Psoriasis: Treatment and Pathogenesis
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences