What's changed: IL-23 inhibitors are no longer just for adults
For years, IL-23 inhibitors were reserved for adults with psoriasis, but recent research has shifted that view. A 2023 review highlights that the IL-23 pathway is now a key target in childhood psoriasis, with trials specifically investigating these drugs in pediatric patients [4]. This marks a clear move away from the old belief that biologics were a last resort for kids, toward earlier consideration in severe cases.
The adult data backing this shift is strong: a 2025 real-world study of over 120 patients found that by 52 weeks, 86-97% of adults achieved PASI75 (a 75% reduction in skin severity), regardless of age [1]. While children aren't just small adults, this high efficacy and good safety profile in adults supports the rationale for using these drugs earlier in pediatric care, especially when the disease is severe or affects quality of life.
Why early use might matter: protecting joints and nails
Early intervention with IL-23 inhibitors may do more than clear skin—it could prevent permanent joint and nail damage. A 2025 study using high-frequency ultrasound in early psoriatic arthritis patients found that 24 weeks of IL-23 inhibitor treatment significantly reduced inflammation in nails and entheses (where tendons attach to bone) [2]. This is crucial because in kids, joint damage can be silent and irreversible, so starting treatment before significant damage occurs is a strong argument for early use.
The same study showed that improvements in nail and enthesis inflammation correlated with reductions in both skin severity (PASI) and joint disease activity (DAPSA) [2]. This means that treating skin inflammation early with IL-23 inhibitors could have a 'two-for-one' effect, potentially staving off arthritis—a major concern in pediatric psoriatic disease.
The catch: not all kids need them, and evidence is still thin
Despite the promise, there's no blanket rule for 'how early' because IL-23 inhibitors aren't for every child. The adult study noted that older patients had a slower initial response—at 12-16 weeks, only 65% of those over 65 achieved PASI75 versus 90% of younger adults—but by 52 weeks, the gap closed [1]. This suggests that even if a child doesn't respond immediately, patience can pay off, but it also means doctors should monitor closely and not switch too quickly.
The biggest limitation is that pediatric-specific data are still emerging. The 2023 review calls for more trials in children [4], and the axial arthritis study (a 2025 Lancet viewpoint) warns that IL-23 inhibitors may not work for all types of psoriatic disease—particularly in certain spinal involvement [3]. So, while early use is gaining support, it should be guided by a specialist who can weigh the child's specific symptoms, severity, and response to other treatments.
About These Sources
This answer is built on 4 peer-reviewed studies — published from 2023 to 2025, 3 from 2024 or later, 1 in Q1 journals — selected as the most relevant from 4 studies that passed quality screening, drawn from 56 papers retrieved from a database of over 500 million.
Sources used in this answer
Efficacy and Safety of IL‐17 and IL‐23 Inhibitors in Elderly Patients With Plaque Psoriasis: A Real‐World Study
In a real-world study of 121 adults with plaque psoriasis, IL-23 inhibitors (and IL-17 inhibitors) achieved high long-term response rates—86-97% reached PASI75 by 52 weeks—with no significant difference between age groups or drug classes, though older patients had a slower initial response.
The evaluation of effectiveness of IL-17 and IL-23 inhibitors on nail and enthesis involvement in early psoriatic arthritis patients by high-frequency ultrasonography: a single-centre prospective proof-of-concept study
In a proof-of-concept study of 20 early psoriatic arthritis patients, 24 weeks of IL-23 or IL-17 inhibitor treatment significantly reduced nail and enthesis inflammation on ultrasound, with improvements correlating with reductions in skin and joint disease activity.
Time to lift the moratorium on IL-23 inhibitors for axial psoriatic arthritis
A 2025 viewpoint argues that IL-23 inhibitors should be reconsidered for axial psoriatic arthritis, citing post-hoc trial analyses and real-world evidence of benefit, despite previous recommendations against their use based on negative trials in ankylosing spondylitis.
Biological therapies for the treatment of psoriasis in pediatrics
A 2023 review highlights that IL-23 inhibitors are being investigated for pediatric psoriasis, with growing interest in targeting the IL-23 axis in childhood, though it calls for more efficacy and safety data in this population.