In comparing the onset of action among antipsoriatic therapies, brodalumab continues to demonstrate the fastest time to achieve meaningful relief in patients with plaque psoriasis, according to a study published in the Journal of Drugs in Dermatology.

The investigators of this study sought to compare the time for patients to achieve clinically meaningful improvement from antipsoriatic drugs used to treat moderate to severe psoriasis.

Investigators performed a synthesis of efficacy data from previously reviewed drugs (brodalumab, secukinumab, ustekinumab, and ixekizumab) and updated their analyses to include clinical data for new biologics, tildrakizumab and certolizumab pegol. For drugs with a single or small range of dosage, the time to achieve clinically meaningful outcomes was calculated from pooled data; for studies that used high or low dosages of a drug, the data was stratified according to dose. The primary study end point was the time necessary for 25% of a study population to achieve clinically meaningful improvement defined as a Psoriasis Area and Severity Index (PASI) 75 score; the secondary end point was the time necessary for 25% of a study population to achieve a mean PASI 50 score.

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In previous reviews, the weighted mean time for 25% of patients to achieve PASI 75 ranged from 2.1 weeks to 9.5 weeks, with brodlumab having the fastest onset of action at 2.1 weeks (95% CI, 2.01-2.26). Compared with other antipsoriatic drugs, certolizumab pegol was among the slowest with a mean 7.1 weeks for high-dose certolizumab pegol and 6.9 weeks for low-dose certolizumab pegol. Tildrakizumab performed similarly to ustekinumab and adalimumab. The weighted mean time for 25% of patients to achieve PASI 50 ranged from 1.8 weeks to 10.9 weeks, with brodalumab having the fastest time to improvement (1.8 weeks; 95% CI, 1.8-1.9) and certolizumab pegol having among the slowest times to improvement (7.0 weeks with high-dose and 7.4 weeks with low dose).

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Limitations to the review included different study designs and qualities, which may have affected the precision of time estimates for the onset of action. Furthermore, different ethnic and regional characteristics, as well as psoriasis reported in different body regions, have varying responses to antipsoriatic drugs, limiting the study’s generalizability.

Among antipsoriatic drugs, brodalumab continues to have the most rapid onset of action available, even with the development of new biologic therapies such as certolizumab pegol and tildrakizumab.

Dr. Lebwohl declares multiple associations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

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Yao CJ, Lebwohl MG. Onset of action of antipsoriatic drugs for moderate-to-severe plaque psoriasis: An update. J Drugs Dermatol. 2019;18(3):229-233.