Psoriasis

Anti-Il-17 Biologic Agents Offer Greater Cumulative Clinical Benefit in Psoriasis Management

Avatar photoBrandon May
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Psoriasis is a chronic, immune-mediated skin disorder, affecting ~2% of the US general population.7 Characteristic findings include well-demarcated symmetrical erythematous patches or plaques with silver scales. Psoriasis appears to be more common in people with certain comorbidities, including HCV. In a single-institution study from Japan, where estimated prevalence is <1%, HCV infection was identified in 7.5% of psoriatic patients (54 of 717).8,9 In ~80% of cases, HCV infection preceded onset of psoriasis, but HCV treatment was also found to cause new lesions or exacerbate existing ones.8 A recently published small study assessed the relationship between HCV and psoriasis by comparing biopsies of patients with psoriatic with (n=7) and without (n=10) HCV.10 The findings suggest HCV increases susceptibility to psoriasis by upregulating inflammatory cytokines, including cathelicidin, TLR9, and interferon γ.10 The association between HCV, HCV treatment, and psoriasis requires elucidation in larger, prospective studies. Photo Credit: Hercules Robinson.

Psoriasis is a chronic, immune-mediated skin disorder, affecting ~2% of the US general population.7 Characteristic findings include well-demarcated symmetrical erythematous patches or plaques with silver scales. Psoriasis appears to be more common in people with certain comorbidities, including HCV. In a single-institution study from Japan, where estimated prevalence is <1%, HCV infection was identified in 7.5% of psoriatic patients (54 of 717).8,9 In ~80% of cases, HCV infection preceded onset of psoriasis, but HCV treatment was also found to cause new lesions or exacerbate existing ones.8

A recently published small study assessed the relationship between HCV and psoriasis by comparing biopsies of patients with psoriatic with (n=7) and without (n=10) HCV.10 The findings suggest HCV increases susceptibility to psoriasis by upregulating inflammatory cytokines, including cathelicidin, TLR9, and interferon γ.10 The association between HCV, HCV treatment, and psoriasis requires elucidation in larger, prospective studies.

Photo Credit: Hercules Robinson.

Greater cumulative clinical benefit was seen with ixekizumab (at 12 and 16 weeks) and brodalumab (at 12 weeks) than with all the biologic agents studied for the treatment of psoriasis.

Compared with other biologic agents commonly used for the treatment of psoriasis, both brodalumab and ixekizumab feature a greater cumulative clinical benefit for the improvement of Psoriasis Area and Severity Index (PASI) responses at 12 and 16 weeks, study data published in the Journal of the American Academy of Dermatology suggests.

The study was a network meta-analysis of published phase 3 clinical trials that investigated various biologic agents for the management of moderate to severe psoriasis. Only trials that reported data on approved biologic agents or those likely to be approved were included in the study. In addition, the investigators focused on trials that reported PASI 75, PASI 90, and PASI 100 responses.

In this analysis, a total of 28 trials that studied the use of ixekizumab, adalimumab, guselkumab, secukinumab, ustekinumab, etanercept, tildrakizumab, brodalumab, and infliximab were included. Based on the included trials, the objective was to compare cumulative benefits for the PASI response endpoints in biologic agents at 12 and 16 weeks. The area under the curve (AUC) measure was used to identify the cumulative clinical benefit of responders to each therapy.

Compared with anti-IL-23 and other biologic agents, anti-IL-17 possessed greater cumulative clinical benefits on the PASI 75, PASI 90, and PASI 100 over the course of 12 and 16 weeks in patients with psoriasis. Ixekizumab and brodalumab, both anti-IL-17 biologic agents, had similar percentages of maximum AUC at 12 weeks. In addition, ixekizumab and brodalumab displayed greater cumulative benefits than secukinumab, guselkumab, infliximab, adalimumab, ustekinumab, and etanercept.

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According to the investigators, the early rapid PASI improvement appeared to be the greatest contributing factor to ixekizumab’s higher percentage of maximum AUC. For PASI 75, the median percentage of maximum AUC was 66% for 80 mg ixekizumab every 2 and 4 weeks, 57% for 300 mg secukinumab every 4 weeks, 52% for 100 mg guselkumab every 8 weeks, 44% for 40 mg adalimumab every 2 weeks, and 42% for ustekinumab at 45-mg and 90-mg doses every 12 weeks. Corresponding PASI 90 and PASI 100 percentages of maximum AUC estimates were also highest for ixekizumab and lowest for ustekinumab and adalimumab, respectively.

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Analysis limitations were the inclusion of studies that only reported cumulative benefit during a 12- to 16-week period, the reliance on only 1 clinical efficacy measurement, and the lack of evaluation of quality of life and safety outcomes.

Based on the findings of their study, the investigators wrote that the “maximum cumulative clinical benefit percent achieved is a useful metric for capturing the speed and magnitude of clinical responses for psoriasis biologics and may help clinicians differentiate among treatment choices for their patients.”

Disclosure: This clinical trial was supported by Eli Lilly and Company. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Warren RB, Gooderham M, Burge R, et al. Comparison of cumulative clinical benefits of biologics for the treatment of psoriasis over 16 weeks: results from a network meta-analysis [published online December 26, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.12.038

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