Treatment with interleukin (IL)-17 receptor A (RA) inhibitor brodalumab was well tolerated and effective for managing psoriasis in patients who had previously experienced treatment failure with other IL-17 RA inhibitors, according to study findings published in Dermatologic Therapy.
Researchers from Denmark evaluated the safety and efficacy of brodalumab in 20 patients (median age, 50 years) who had previously experienced primary and/or secondary failure with 1 or more IL-17RA inhibitors. Before baseline, the researchers implemented a 4-week washout period of all systemic psoriasis treatments. In the open-label portion of the trial, patients received 210 mg brodalumab at weeks 0, 1, 2, and then every second week.
Patients had clinic visits after 4 weeks and 12 weeks of treatment. Those who had not experienced an absolute psoriasis area and severity index (PASI) 2 or lower and/or PASI of 75% (PASI75) after 12 weeks were labeled nonresponders at each subsequent visit and ended treatment at week 12. Those who did respond to treatment, however, continued therapy and visited the clinic at weeks 26 and 52. In addition to evaluating PASI and PASI75, the investigators also examined changes in plasma cytokine levels after 12 weeks of treatment.
At baseline, the median PASI was 13.5. A total of 14 patients had previously received treatment with secukinumab, and 6 patients had previously received ixekizumab and secukinumab. Reasons reported for discontinuation of these therapies included secondary failure(s) (n=16), primary failure(s) (n=3), and both previous secondary and primary failure (n=1).
The majority of patients, 70%, achieved either PASI75 and/or PASI 2 or lower after 12 weeks. In addition, 40% had achieved PASI90 and 15% had achieved PASI100. Approximately 45% patients completed the entire 52-week trial, with 35% of these patients still having PASI75 throughout this long-term period. A total of 4 patients discontinued brodalumab after 26 weeks due to loss of response, while 2 patients halted treatment between 26 and 52 weeks because of adverse events (AEs).
During the 52 weeks, 17 of 20 patients experienced any AE, but no serious AEs or deathswere reported. Those who responded to brodalumab showed lower levels of both tumor necrosis factor (TNF)-α and IL-6 at baseline compared with patients who did not respond to therapy (TNF-α, P =.041; IL-6, P =.0054).
Limitations of the study included its small sample size, lack of a control or comparison arm, and the limited number of patients with prior exposure to ixekizumab.
Despite these limitations, the researchers concluded that “brodalumab can be an effective choice of drug for patients with psoriasis who have previously experienced treatment failure of one or more IL-17A inhibitors.”
Disclosure: This clinical trial was supported by Leo Pharma A/S. Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.
Loft N, Bregnhøj A, Fage S, et al. Effectiveness of brodalumab after previous treatment failure of interleukin-17A inhibitors in patients with psoriasis. Dermatol Ther. Published online August 21, 2021. doi:10.1111/dth.15106