Ixekizumab Superior for Moderate to Severe Plaque Psoriasis

Ixekizumab is more efficacious than secukinumab for the treatment of severe plaque psoriasis over 12 weeks of therapy, according to results of a recent meta-analysis published in the British Journal of Dermatology.

The investigators conducted an indirect comparison of efficacy and quality of life during the initial 12 weeks of treatment with ixekizumab vs secukinumab in patients with plaque psoriasis. Inclusion criteria for the selected studies were age ≥18 years, a diagnosis of chronic plaque psoriasis ≥6 months prior to randomization, and psoriasis that was moderate to severe at randomization.

Study end points included Psoriasis Area and Severity Index (PASI) improvement of at least 75%, 90%, and 100% (PASI 75, PASI 90, and PASI 100, respectively), and Dermatology Life Quality Index 0/1 response rates for approved doses of ixekizumab (160 mg at week 0, then 80 mg every 2 weeks for the first 12 weeks) and secukinumab (300 mg at weeks 0, 1, 2, 3, and 4, then 300 mg every 4 weeks). Data were collected from active (etanercept and ustekinumab) and placebo-controlled studies.

In meta-analyses of studies with active comparators, PASI 90 response rates were 12.7% (95% CI, 5.5%-19.8%; P =.0005), 10.0% (95% CI, 2.1%-18.0%; P =.01), and 11.2% (95% CI, 3.2%-19.1%; P =.006) higher, and PASI 100 response rates were 11.7% (95% CI, 5.9%-17.5%; P <.001), 12.7% (95% CI, 6.0%-19.4%; P <.001), and 13.1% (95% CI, 6.3%-19.9%; P <.001) higher with ixekizumab compared with secukinumab, using the Bucher, Signorovitch total, and Signorovitch separate methods, respectively — all of which were statistically significant. Dermatology Life Quality Index response rates at week 12 did not differ significantly.

The investigators concluded that even with adjustment for cross-trial variations in baseline characteristics and treatment effect modifiers, ixekizumab was associated with significantly higher relative PASI responses compared with secukinumab.

Reference

Warren RB, Brnabic A, Saure D, et al. Matching-adjusted indirect comparison of efficacy in patients with moderate-to-severe plaque psoriasis treated with ixekizumab versus secukinumab [published online November 24, 2017]. Br J Dermatol. doi: 10.1111/bjd.16140