Across The Rheum Podcast: Part 3 - Clinical Utility and Positioning of IL-23 Agents

In Part 3 of the Across the Rheum podcast series, Dr. Sergio Schwartzman concludes the three-part discussion on the IL-23 paradigm in psoriatic arthritis (PsA) with a deep dive into clinical utility, treatment positioning, and real-world decision-making. Building on prior episodes that covered immunologic mechanisms and comparative trial data, this final installment focuses on how IL-23 inhibitors are being integrated into modern PsA treatment algorithms.

Joined by Jessica Farrell, PharmD, and Dr. Monica Schwarzman, the discussion explores where IL-23 inhibitors fit relative to methotrexate, TNF inhibitors, and IL-17 inhibitors, with thoughtful analysis of treatment persistence, safety profiles, radiographic progression, and comorbidity considerations, including inflammatory bowel disease. The episode also addresses evolving practice patterns, payer access considerations, and why many clinicians are moving toward earlier use of targeted biologic therapy in appropriate patients.

Additional insights include the role of radiographic progression prevention, interpretation of modified Sharp scores, and future directions in PsA care—such as axial psoriatic arthritis, combination biologic therapy, difficult-to-treat disease, and emerging oral and long-acting agents.

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