Ixekizumab Superior to Etanercept, Ustekinumab in Moderate to Severe Psoriasis

Investigators found ixekizumab to achieve higher treatment targets in patients with plaque psoriasis.

In patients with moderate to severe plaque psoriasis, treatment with ixekizumab is associated with a higher level of skin clearance than etanercept, ustekinumab, or placebo, as dictated by National Psoriasis Foundation (NPF) treatment targets, study results in the Journal of the American Academy of Dermatology suggested.

Investigators analyzed body surface area (BSA) data from the randomized, phase 3 UNCOVER-1, UNCOVER-2, UNCOVER-3, and IXORA-S trials in this study. Participants had moderate to severe plaque psoriasis and were treated with etanercept, ixekizumab, or placebo in the UNCOVER trials, whereas participants in the IXORA-S trials received ixekizumab, ustekinumab, or placebo.

Researchers evaluated BSA measurement data to identify response rates in accordance with the NPF recommendations. These response rates were established to find targets that may inform clinical decision making. According to the NPF, response rates were classified as acceptable response (BSA ≤3% or BSA improvement of ≥75% at 12 weeks) and target response (BSA ≤1% at 12 weeks and every 6 months thereafter).

A significantly higher proportion of patients in the UNCOVER trials who were treated with ixekizumab every 2 weeks achieved an acceptable response at week 12 compared with patients who were treated with either etanercept or placebo (73.9% vs 35.7% and 3%, respectively; P <.001 for all). Treatment with ixekizumab was also associated with a higher proportion of patients achieving a target response at week 12 (51.8% vs 14.9% and 0.6%, respectively; P <.001 for all). In the maintenance period of the IXORA-S study, the target response was higher with ixekizumab than ustekinumab at 52 weeks (71.3% vs 56.6%, respectively; P =.0086).

Limitations of the study were its retrospective nature and the analysis of trial data that may not reflect current real-world clinical practice.

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Despite the study’s limitations, the investigators suggested their findings “highlight the importance of using clinical trial data as one useful measure of how a therapy will perform in helping patients achieve treatment targets in the real world.”

Disclosure: This clinical trial was supported by Eli Lilly and Company. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Armstrong A, Amato D, Huster W, Ojeh C, Van Voorhees AS. Achievement of the National Psoriasis Foundation treatment targets with ixekizumab: pooled analyses from four clinical studies [published online September 25, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.09.030