Ixekizumab Leads to Earlier Skin Clearance Than Guselkumab in Patients With Moderate to Severe Psoriasis

plaque psoriasis
plaque psoriasis
Skin and nail clearance and patient-reported outcomes for patients with psoriasis treated with either ixekizumab or guselkumab are compared.

Treatment with ixekizumab is associated with similar skin clearance as treatment with guselkumab in patients with moderate to severe plaque psoriasis, but ixekizumab appears more effective for clearing nails and improving skin clearance more rapidly than guselkumab during a 24-week period, study findings published in the British Journal of Dermatology suggests.

In the phase 4 IXORA-R trial (NCT03573323), adults with moderate to severe plaque psoriasis were randomly assigned to subcutaneous injections of either ixekizumab (n=520) or guselkumab (n=507) at approved dosing. The doses from weeks 12 to 24 included 80 mg every 4 weeks for ixekizumab and 100 mg at weeks 12 and 20 for guselkumab.

Although the primary efficacy endpoint of the trial was achievement of PASI 100 at week 12, this analysis examined the superiority of ixekizumab in terms of Psoriasis Area and Severity Index (PASI) 100 at week 24. The 24-week analysis was examined in 465 patients receiving ixekizumab and 459 patients receiving guselkumab.

Significantly more patients treated with  ixekizumab achieved PASI 100 and Physician’s Global Assessment of Disease score of 0 as early as week 2 and through week 16 (P <.01). These changes indicated to the researchers that treatment with ixekizumab was associated with greater skin clearance during this timeframe.

By week 24, however, treatment with ixekizumab was noninferior to guselkumab for PASI 100 (50% vs 52%, respectively; difference, -2.3%; 95% CI, -8.4-3.8; P =.41).

A significantly greater percentage of patients in the ixekizumab treatment group experienced completely clear nails at week 24 (52% vs 31%; P =.007). In addition, patients treated with ixekizumabhad experienced a respective 2 and 7.5 weeks shorter median time to first PASI 50/75/90 and PASI 100 (P <.001 for both).

Treatment with ixekizumab in patients with an itch numerical rating scale (NRS) score of higher than 0 at baseline was also associated with a significantly greater cumulative benefit, including more complete resolution of itch beginning at week 4 and continuing through week 16 (41% vs 33%; P <.05).

Serious adverse events occurred in 3% of patients in each group. No new safety signals were identified in this analysis of the IXORA-R trial.

Limitations of this study was its inclusion of only patients from the United States and Canada as well as the short duration of the trial.

The study investigators noted that the rapidity of response to ixekizumab “is not only important for a patient’s quality of life and satisfaction but also contributes to treatment persistence.”

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.


Blauvelt A, Leonardi C, Elewski B, et al. A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 24-week efficacy and safety results from a randomized, double-blinded trial. Published online September 2, 2020. Br J Dermatol. doi:10.1111/bjd.19509