NEW PERSPECTIVES IN THE TREATMENT OF ULCERATIVE COLITIS IN ADULTS - IL-23 INHIBITORS: EFFICACY AND SAFETY

Abstract

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by recurrent inflammation of the colon resulting from immune dysregulation. Despite the availability of multiple therapeutic options, a substantial proportion of patients fail to achieve sustained remission or develop loss of response to existing therapies. Increasing evidence has identified the interleukin-23 (IL-23)/Th17 pathway as a key mechanism involved in the pathogenesis of UC, leading to the development of selective IL-23 inhibitors as novel therapeutic agents. Purpose: The aim of this study was to review and summarize current evidence regarding the efficacy and safety of IL-23 inhibitors, particularly mirikizumab, risankizumab and guselkumab, in the treatment of moderate-to-severe ulcerative colitis. Methodology: A narrative literature review was performed using PubMed and ClinicalTrials.gov to identify relevant studies investigating IL-23 inhibitors in the treatment of ulcerative colitis. The review included phase II and phase III randomized controlled trials, long term extension studies, real-world observational cohorts, systematic reviews and meta-analyses. Data were extracted and synthesized to provide a comprehensive assessment of the efficacy, safety and evolving therapeutic role of IL-23 inhibitors in ulcerative colitis. Conclusions: Available evidence indicates that IL-23 inhibitors are effective therapeutic options for patients with moderate-to-severe ulcerative colitis. Mirikizumab, risankizumab and guselkumab demonstrated significant improvements in clinical remission, endoscopic healing, histologic outcomes and quality of life. Among these agents, mirikizumab currently has the strongest evidence supporting long-term efficacy and durability of response. IL-23 inhibitors also demonstrated favorable safety profiles, with low rates of serious adverse events and treatment discontinuation. Although further real-world data and head-to-head comparative studies are still needed, selective IL-23 blockade represents a promising advancement in personalized UC treatment strategies.