Background Significantly more patients with moderate‐to‐severe plaque psoriasis treated with the interleukin (IL)‐17A inhibitor ixekizumab vs. the IL‐23p19 inhibitor guselkumab in the IXORA‐R head‐to‐head trial achieved 100% improvement in Psoriasis Area and Severity Index (PASI 100) at Week 12. Objectives To compare skin and nail clearance and patient‐reported outcomes for ixekizumab vs. guselkumab, up to Week 24. Methods IXORA‐R enrolled adults with moderate‐to‐severe plaque psoriasis (static Physician’s Global Assessment [sPGA] ≥3, PASI ≥12, and BSA ≥10%). Statistical comparisons were performed using the Cochran‐Mantel‐Haenszel test stratified by pooled site. Time‐to‐first‐event comparisons were performed using Kaplan‐Meier analysis, and p values were generated using adjusted log‐rank test stratified by treatment group. Cumulative days at clinical and patient‐reported responses (percentage of the maximum area‐under‐the‐curve times study duration) were compared by ANCOVA. Results Of the 1027 patients randomly assigned, 90% completed the trial (465/520 ixekizumab and 459/507 guselkumab). As early as Week 2 and through Week 16, more patients on ixekizumab achieved PASI 100 (p<0·01). At Week 24, ixekizumab was non‐inferior to guselkumab (50% vs. 52%, difference: ‐2·3%), with no statistically significant difference in PASI 100 (p=0·414). More patients receiving ixekizumab showed completely clear nails at Week 24 (52% vs. 31%; p=0·007). The median time‐to‐first PASI 50/75/90 and PASI 100 were 2 and 7.5 weeks shorter, respectively, for patients on ixekizumab versus guselkumab (p<0·001). Patients on ixekizumab also had a greater cumulative benefit, with more days at PASI 90 and 100, Dermatology Life Quality Index of 0 or 1, and itch‐free (p<0·05). Serious adverse event frequency was 3% for each group with no new safety signals. Conclusions Ixekizumab was non‐inferior to guselkumab in complete skin clearance and superior in clearing nails at Week 24. Ixekizumab cleared skin more rapidly in patients with moderate‐to‐severe plaque psoriasis, with a greater cumulative benefit, than guselkumab. Overall, safety findings were consistent with the known safety profile for ixekizumab.

Moderate to severe chronic plaque psoriasis of the hands and/or feet occurs infrequently in the general population; however, this subset of psoriasis vulgaris is of unique clinical interest because of its disproportionately negative impact on quality of life, despite the relatively small body surface area (BSA) affected.^1-5 Treatment for most patients with hand and/or foot psoriasis, including the subset of patients with involvement of palms and/or soles (palmoplantar disease), is unsatisfactory, since topical therapies and/or phototherapy are sometimes ineffective and inconvenient and systemic therapies are limited by potential toxic effects.⁶

Rosacea is a chronic, progressive, inflammatory condition phenotypically subtyped into diagnostic features, major features, and minor/secondary features. There is currently no cure for rosacea, and it carries a significant negative psychosocial burden for afflicted patients. While there are a number of treatment modalities at the disposal of the clinician, clinical experience has suggested a need for updated treatments. The pathogenesis of rosacea is multifactorial; however, this paper will focus on the pivotal role of interleukin 17 (IL-17) in the development and progression of the disease. Furthermore, this paper will explore the mechanism of action of standard rosacea treatments and their effect on different stages of the IL-17 pathway. The standard treatments for rosacea are usually effective in controlling the symptoms of the disease in its mild-to-moderate form; however, their efficacy is diminished in the setting of severe and treatment-resistant rosacea. We hypothesize that IL-17 inhibitors, currently used successfully in psoriasis and psoriatic arthritis, could perhaps be used to treat severe and treatment-resistant papulopustular rosacea in the future; however, clinical trials and case reports will be needed to dictate expanded indications of IL-17 inhibitors. Furthermore, the high cost of IL-17 inhibitors presently prevents their use in disease states other than psoriasis or psoriatic arthritis.