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No efficacy of anti-IL-23 therapy for axial spondyloarthritis in randomised controlled trials but in post-hoc analyses of psoriatic arthritis-related ‘physician-reported spondylitis’?
  1. Juergen Braun1,
  2. Robert BM Landewé2,3
  1. 1 Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
  2. 2 Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands
  3. 3 Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
  1. Correspondence to Dr Juergen Braun, Rheumazentrum Ruhrgebiet, Herne 44649, Germany; juergen.braun{at}


The three monoclonal antibodies ustekinumab, guselkumab and risankizumab targeting the p 40 or the 19 subunit of interleukin -23 have now been approved for the indication psoriasis and the former two also for psoriatic arthritis (PsA). Ustekinumab and risankizumab have appeared ineffective in randomised controlled trials with patients with axial spondyloarthritis (axSpA), but post-hoc analyses of PsA trials have now suggested that they may improve back pain symptoms potentially induced by axial inflammation based on PsA. Here we argue that, based on the absence of efficacy in axSpA, this is unlikely and more probably due to generic, non-specific effects, which are not adequately covered by the tools developed for the assessment of inflammation in axSpA.

  • antirheumatic agents
  • arthritis
  • psoriatic
  • biological therapy
  • cytokines
  • spondylitis
  • ankylosing

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  • Handling editor Josef S Smolen

  • Contributors Both authors have equally contributed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.