Abstract
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters. OBJECTIVES: To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis. DESIGN: We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. DATA SOURCES AND METHODS: A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials. RESULTS: Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase. CONCLUSION: IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings. TRIAL REGISTRATION: PROSPERO CRD42024599350.