Clinical, Systemic Inflammatory, and Metabolic Responses to Anti‐IL‐17 and Anti‐IL‐23 Monoclonal Antibodies in Psoriasis: A Comparative Real‐World Study
Berna Solak, Mizgin Gülmez, Sabiyya Özgün, Nilüfer Ertem Günegül, Kemal NasBackground
Clinical scoring systems like PASI are gold standards for evaluating psoriasis treatment, yet they may not fully capture systemic biological responses. We aimed to compare the longitudinal effects of anti‐IL‐17 and anti‐IL‐23 monoclonal antibodies on systemic inflammatory markers and lipid profiles.
Methods
This retrospective cohort study included 237 patients with moderate‐to‐severe plaque psoriasis treated with anti‐IL‐17 ( n = 157) or anti‐IL‐23 ( n = 80) monoclonal antibodies. Clinical severity (PASI, DLQI, and DAPSA), systemic inflammatory indices (NLR, MLR, IBI, and MHR), HDL cholesterol, LDL cholesterol, and triglycerides were evaluated at baseline, Week 4, and Week 16.
Results
Both groups achieved comparable and significant clinical improvements at Week 16, with no significant differences in PASI 75/90 response rates ( p > 0.05). However, clinical score reductions did not correlate with changes in inflammatory markers ( p > 0.05). Anti‐IL‐17 group demonstrated a more rapid systemic response, significantly reducing NLR by Week 4 ( p < 0.001), a change significantly more pronounced than in the anti‐IL‐23 group ( p = 0.041). By Week 16, NLR decreased significantly in both groups, whereas within‐group reductions in MLR and IBI reached significance only in the anti‐IL‐17 group; however, the between‐group differences in these changes were not statistically significant. Conversely, a small but significant reduction in HDL cholesterol was observed exclusively in the anti‐IL‐23 group by Week 16 (median within‐patient change 2.0 mg/dL [IQR −1.0 to 6.0]; p = 0.002), resulting in a significant inter‐class difference ( p = 0.021).
Conclusion
Our comparative analysis suggests that while anti‐IL‐17 and anti‐IL‐23 monoclonal antibodies offer similar clinical efficacy, they may differ in their systemic inflammatory and metabolic effects. Anti‐IL‐17 biologics were associated with an earlier reduction in NLR. Conversely, the significant reduction in HDL levels observed with anti‐IL‐23 biologics is of small magnitude and uncertain clinical significance, but may warrant metabolic monitoring until confirmed in larger, longer cohorts. The lack of correlation between skin clearance and biological stabilization suggests that clinical scores alone may be insufficient to monitor the total systemic burden in psoriasis.