ABSTRACT
BACKGROUND: Interleukin (IL)-23, a member of the IL-12 family, has emerged as an important cytokine that bridges the innate and adaptive immune systems and plays a critical role in the development of a wide spectrum of immune-mediated inflammatory disorders (IMIDs). It can be considered a gatekeeper of T helper 17 (Th17) cells development and expansion that subsequently produces several mediators that promote inflammation. The inhibition of IL-23 is a potential therapeutic approach for several inflammatory diseases, such as psoriasis, psoriatic arthritis, and inflammatory bowel disease. OBJECTIVE: This work aims to address the overview of the immunobiology of IL-23 associated with some of the most frequent IMIDs and the current pipeline of its inhibition. METHODS: We conducted a narrative review elucidating data about 1) the overview of the immunobiology of IL-23 associated with immune-mediated inflammatory disorders in specific diseases, such as psoriasis, psoriatic arthritis, and inflammatory bowel disease; 2) therapeutic approaches targeting the IL-23 pathway (IL-23 inhibitor drugs approved by international agencies); and 3) novel therapeutic perspectives. The search strategy was conducted in the relevant database with terms related to the proximity to IL-23 or immuno-mediated. RESULTS AND CONCLUSIONS: Existing and emerging therapeutic biologics targeting the IL-23/IL-17 pathway are promising options to treat IMIDs while the knowledge of the pathophysiology of those conditions and the contribution of the IL23/IL-17 continues to grow. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7017 Citation: Galli Sanchez AP, Castanheiro da Costa A, Del Rey C, et al. The overview of the immunobiology of interleukin-23 associated with immune-mediated inflammatory disorders. A narrative review. J Drugs Dermatol. 2023;22(4):375-385. doi:10.36849/JDD.7017.
Subject(s)
Arthritis, Psoriatic , Inflammatory Bowel Diseases , Psoriasis , Humans , Arthritis, Psoriatic/drug therapy , Interleukin-23/metabolism , Interleukin-17/metabolism , Immunomodulating Agents , Inflammatory Bowel Diseases/drug therapyABSTRACT
Objetivo: Estimar o custo por resposta dos medicamentos biológicos no tratamento da psoríase moderada a grave sob as perspectivas do Sistema de Saúde Suplementar (SSS) e Sistema Único de Saúde (SUS), representado pela Secretaria de Estado da Saúde de São Paulo, no Brasil. Métodos: Quatro medicamentos biológicos foram considerados na análise: adalimumabe, etanercepte, infliximabe e ustequinumabe. Os dados de eficácia foram obtidos de uma metanálise publicada, que avaliou a resposta PASI 75 dos medicamentos na semana 24 de tratamento. O custo do tratamento foi obtido considerando o preço de aquisição dos medicamentos, conforme perspectiva analisada, e a posologia preconizada na bula de cada um deles. Análise de sensibilidade foi conduzida a fim de avaliar o impacto das incertezas nos resultados encontrados. Resultados: A análise mostrou que, sob a perspectiva do SSS, ustequinumabe apresentou o menor custo por resposta PASI 75 (R$ 66.371) por ano de tratamento, seguido por infliximabe (R$ 139.605), adalimumabe (R$ 152.501) e etanercepte (R$ 179.812). Resultado semelhante foi observado na perspectiva do SUS, no qual ustequinumabe apresentou custo por resposta PASI 75 de R$ 47.229, seguido por infliximabe (R$ 75.145), adalimumabe (R$ 90.292) e etanercepte (R$ 130.523). Ajuste de dose para ustequinumabe mostrou ser o parâmetro mais sensível na análise de sensibilidade. Conclusão: Avaliações econômicas são ferramentas importantes para auxiliar gestores de saúde no processo de tomada decisão. A presente análise mostrou que, dentre as alternativas comparadas, ustequinumabe é o medicamento biológico que apresenta o menor custo por resposta PASI 75 (mais custo-efetivo), independentemente da perspectiva analisada (público ou privado).
Objective: To estimate the cost per responder of biologic drugs in moderate to severe psoriasis treatment from the private and public (State Health Secretariat of São Paulo) perspectives in Brazil. Methods: Four biologic drugs were considered in the analysis: adalimumab, etanercept, infliximab and ustekinumab. Efficacy data was obtained from a published metanalysis, which evaluated PASI 75 response after treatment with biologic drugs after 24 weeks of treatment. The cost of treatment was obtained considering drug acquisition cost, according to the analyzed perspective, and dosage according to each drug information label. Sensitivity analysis was performed to evaluate the impact of uncertainty in the results. Results: The analysis demonstrated that, from the private perspective, ustekinumab presented lower cost per PASI 75 response (R$ 66,371), in one year of treatment, followed by infliximab (R$ 139,605), adalimumab (R$ 152,501), and etanercept (R$179,812). Similar results were found from public perspective, with ustekinumab presenting a cost per PASI 75 response of R$ 47,229 per year of treatment, followed by infliximab (R$ 75,145), adalimumab (R$ 90,292) and etanercept (R$ 130,523). Dose adjustment for ustekinumab was shown to be the most sensitive parameter in the sensitivity analysis. Conclusion: Economic evaluations are important tools to support payers during the decision making process. The current analysis demonstrated that, among compared options, ustekinumab is the biologic with the lowest cost per PASI 75 responder (more cost-effective), regardless the perspective considered (public or private).
