Brodalumab is an efficacious treatment for patients with moderate to severe plaque psoriasis, with results similar to those with ustekinumab treatment, regardless of prior exposure or response to biologic therapy, according to the results of 2 identically designed, multicenter, randomized, double-blind, placebo-controlled and active comparator-controlled parallel-group studies — AMAGINE-2 and AMAGINE-3 (ClinicalTrials.gov identifiers: NCT01708603 and NCT017808629) — published in the British Journal of Dermatology.
The investigators sought to examine the impact of prior biologic exposure on the efficacy and safety of brodalumab and ustekinumab in patients with moderate to severe plaque psoriasis. Patients were treated with brodalumab (210 mg once every 2 weeks or 140 mg every 2 weeks), ustekinumab, or placebo.
Efficacy end points of the studies included Psoriasis Area and Severity Index (PASI 75) score and Physician’s Global Assessment measure; PASI 100 and Dermatology Life Quality Index and Psoriasis Symptom Inventory. Adverse events were recorded throughout.
Among a total of 493 patients, 27% of those treated with brodalumab 210 mg every 2 weeks and 159 of those treated with brodalumab 140 mg every 2 weeks had received prior biologic therapy. Of these participants, 12% and 10%, respectively, reported that biologic therapy had previously failed.
The efficacy of brodalumab in patients with and without previous biologic exposure was statistically equivalent, with 40.9% and 39.5% of those who had never received biologic therapy and those who had received biologic therapy, respectively, attaining PASI 100 at week 12, compared with 21.1% and 17.0%, respectively, of those treated with ustekinumab (P <.001 for both).
Moreover, in patients in whom biologic therapy had been successful or had failed, 41.7% and 32.0%, respectively, achieved PASI 100, compared with 21.1% and 11.3%, respectively, with ustekinumab. Tolerability between the treatments was similar and did not seem to be affected by the use of prior biologic therapies.
The investigators concluded that the efficacy of brodalumab 210 mg every 2 weeks was similar regardless of previous biologic exposure (P =.31, P =.32, and P =.64 for PASI 75, PASI 90, and PASI 100, respectively). Nearly twice as many patients treated with brodalumab 210 mg every 2 weeks achieved PASI 100 or complete clearance at week 12, compared with ustekinumab-treated patients, with the differences most evident in those in whom prior biologics had failed.
Papp KA, Gordon KB, Langley RG, et al. Impact of previous biologic use on efficacy and safety of brodalumab and ustekinumab in patients with moderate-to-severe plaque psoriasis: integrated analysis of AMAGINE-2 and AMAGINE-3 [published online February 28, 2018]. Br J Dermatol. doi: 10.1111/bjd.16464