Landscape of anti-IL-23 therapy in inflammatory bowel disease: recent advances

Inflammatory bowel disease (IBD) commonly requires advanced therapies to induce and maintain durable remission. Interleukin (IL)-23 is a proinflammatory heterodimeric cytokine composed of a p40 subunit, which is shared with IL-12 and a unique p19 subunit. There are multiple streams of evidence that implicate IL-23 in the pathogenesis and pathophysiology of IBD and it has emerged as a crucial therapeutic target in IBD and several immune-mediated inflammatory diseases. Risankizumab, mirikizumab and guselkumab are monoclonal antibodies that selectively target the IL-23p19 subunit and offer a novel mechanism of action. This narrative review summarises key efficacy and safety data from the clinical trial programmes, highlights practical implications for their use in IBD, and reviews available data regarding their positioning in the rapidly expanding landscape of IBD treatments.