Superior Clinical and Economic Value of IL ‐23 Inhibitors Versus Adalimumab Biosimilars in Plaque Psoriasis

BACKGROUND: In recent years, the introduction of interleukin (IL)-23 inhibitors has revolutionized psoriasis treatment, allowing the majority of patients to achieve a long-term, complete clinical control of the disease. Nevertheless, there are no real-world studies exploring the cost benefit ratio of these new drugs compared to the currently most prescribed therapies as adalimumab biosimilars. METHODS: We performed a retrospective study to evaluate the clinical effectiveness, measured as Psoriasis Area and Severity Index (PASI)90-number needed to treat (NNT) and the cost-effectiveness of IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab) in patients with moderate to severe psoriasis as compared to adalimumab biosimilars (imraldi, hyrimoz, yuflima, and amgevita). Assessments were performed at Weeks 16 and 52. RESULTS: Our analysis included 616 patients with moderate to severe psoriasis who had been treated with adalimumab biosimilars or an anti-IL-23 inhibitor for at least 16 weeks. Overall, IL-23 inhibitors were shown to be more effective compared to adalimumab biosimilars, with significantly lower NNT. Risankizumab achieved the highest PASI90 response rates, whereas guselkumab had the most favorable incremental cost per PASI90 responder at Weeks 16 and 52. CONCLUSIONS: Our study highlights the substantial clinical benefit of IL-23 inhibitors over adalimumab biosimilars, with guselkumab as the more cost-effective option than the other IL-23 inhibitors for the real-world management of moderate-to-severe psoriasis.