Comparative efficacy and safety of IL-17 and IL-23 inhibitors for moderate-to-severe psoriasis in Asian populations: a systematic review and meta-analysis

Psoriasis is a chronic inflammatory skin disorder affecting a significant portion of the global population. Biologics targeting the IL-17 and IL-23 pathways are effective in treating moderate-to-severe psoriasis; however, most clinical trials have been conducted in Western populations, leaving limited data on their efficacy and safety in Asian populations. Ethnic differences due to genetic and environmental factors can influence treatment responses. This meta-analysis evaluates the efficacy and safety of IL-17/23 inhibitors in Asian patients with moderate-to-severe psoriasis. A systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2019 and 2025 was conducted in accordance with the PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Embase, Scopus and clinicaltrial.gov databases to identify studies evaluating IL-17 and IL-23 inhibitors in Asian adults with moderate-to-severe psoriasis. Eligible studies compared these biologics with placebo or active comparators. The primary outcome was treatment efficacy, assessed by improvement in Psoriasis Area and Severity Index (PASI). Secondary outcomes included treatment-emergent adverse events (AEs). Data were pooled using random-effects models, and results were expressed as Odds ratios (RRs) with 95% confidence intervals (CIs). A total of 30 randomized controlled trials (RCTs) involving 14,000 Asian and mixed-ethnicity participants were included. The meta-analysis demonstrated a significant overall efficacy advantage of IL-17 and IL-23 inhibitors over placebo or active comparators (log OR = 1.25; 95% CI 0.98–1.52; p < 0.0001). Subgroup analyses confirmed consistent treatment responses across efficacy measures—PASI 75 (log OR = 1.36; 95% CI 0.97–1.75; I² = 64.5%) and PASI 90 (log OR = 1.23; 95% CI 0.87–1.58; I² = 92.4%)—as well as across biologic classes (IL-17: log OR = 1.43 [1.09–1.77]; IL-23: log OR = 1.04 [0.60–1.49]). When stratified by population, efficacy remained high among Asian cohorts (log OR = 1.40 [1.17–1.62]) and mixed populations (log OR = 1.08 [0.51–1.65]). Safety analyses showed that treatment-emergent adverse events (TEAEs) were mostly mild to moderate (50–85% for IL-17, 64–92% for IL-23), and serious adverse events (SAEs) occurred in < 5% of patients, without treatment-related deaths or unexpected immune-mediated events. IL-17 and IL-23 inhibitors demonstrate high efficacy and favorable safety profiles in Asian adults with moderate-to-severe psoriasis, consistent with global evidence. Both biologic classes achieved substantial clinical improvements in PASI with low rates of serious adverse events.