Patients with psoriasis treated with interleukin-23 inhibitors have a lower risk of liver disease compared to untreated individuals, a study suggests.

US researchers examined medical records from 5,502 psoriasis patients (mean age 50; 48% female) newly prescribed IL-23 inhibitors, propensity score matching them with 5,491 controls who hadn’t received biologic treatment.

Findings showed that IL-23 inhibitor therapy was associated with a 36.5% lower four-year risk of new incident liver disease compared to biologic-naïve patients and a 65.4% risk reduction in new liver fibrosis and cirrhosis diagnoses.

The researchers, which included dermatologists from Boston’s Brigham and Women’s Hospital, noted patients initiating biologics might have greater mean disease severity, although this would introduce bias towards higher incidence.

Writing in the Journal of the American Academy of Dermatology [link here], they said evidence on the hepatic impact of psoriatic therapies was limited. Existing studies mostly involved small sample sizes and single-centre designs.

“Prior studies suggest that IL-23 may promote liver fibrosis through effects on inflammatory cells, hepatic stellate cell activation, and pathological tissue remodelling, suggesting a possible mechanistic role,” the researchers said.

“More research is needed to support our findings, and to determine whether IL-23i have intrinsic hepatoprotective effects, or whether they modulate liver disease through broader anti-inflammatory or metabolic effects.”

While comorbidities were controlled for, the researchers noted that geographic variations in availability of the biologics and potential differences in socioeconomic status and healthcare access between cohorts might have influenced outcomes.