Brodalumab Improves Psoriasis in Patients Previously Unresponsive to Therapy

A well demarcated irregularly shaped and slightly raised large red lesion with silvery scale in a patient with chronic plaque psoriasis.
Investigators examined the efficacy of brodalumab, an interleukin-17 receptor-A antagonist to treat moderate to severe psoriasis in patients who had no clinical response with prior anti-interleukin-17A therapies.

Brodalumab, an interleukin-17 receptor-A antagonist, appears to improve moderate to severe psoriasis in patients who have not responded to prior anti-interleukin-17A therapies, according to study results published in the Journal of the American Academy of Dermatology.

In the open-label trial, a total of 39 patients with moderate to severe psoriasis were enrolled at 3 sites. Only patients who had previously received either secukinumab or ixekizumab for ≥3 months and did not achieve a 75% reduction in their Psoriasis Area and Severity Index (PASI-75) score from baseline were included.

Participants were treated with a subcutaneous injection of 210 mg brodalumab  for ≤16 weeks. The percentage of patients who achieved a score of 0 (clear) or 1 (almost clear) on the Physician’s Global Assessment at 16-week follow-up comprised the primary end point, and a secondary end point included improvement in PASI scores.

Approximately 76%, 50%, and 32% of the 34 patients who completed the trial achieved PASI-75, a 90% reduction in their PASI (PASI-90) score, and a 100% reduction in their PASI (PASI-100) score, respectively, at follow-up. The majority of patients (71%) achieved a static Physician Global Assessment of 0 or 1. In all 39 patients, the last observation showed that 69%, 44%, and 28% of patients achieved PASI-75, PASI-90, and PASI-100 scores, respectively, and approximately 62% of these patients had a static Physician Global Assessment of 0 or 1. Only 6 adverse events were observed, none of which were considered associated with the study drug.

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Study limitations include the small patient sample, short follow-up, lack of a randomized control, and the open-label design.

“Overall, these findings suggest that brodalumab may be a good treatment option for psoriasis patients who have failed other biologics, including the anti-IL-17A agents,” the researchers wrote. “While many factors must be considered in choosing the best treatment for psoriasis patients, efficacy is certainly among the most important.”

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Kimmel G, Chima M, Kim HJ, et al. Brodalumab in the treatment of moderate-to-severe psoriasis in patients who have previously failed treatment with anti-interleukin-17A therapies[1]  [published online May 9, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.05.007