Secukinumab Dose-Tapering Regimen Shows Potential for Psoriasis

A 300-mg dose-tapering regimen of secukinumab may be effective for the treatment of moderate to severe psoriasis, according to study results published in Dermatologic Therapy.

Patients (N=80) with moderate to severe, plaque-type psoriasis defined as a Psoriasis Area Severity Index (PASI) score of at least 10 or body surface area (BSA) of 10% were recruited at the Second Affiliate Hospital in China between 2020 and 2022. Patients received four 300 mg subcutaneous secukinumab injections during treatment initiation. At week 4, the improvement in PASI scores guided subsequent injections, in which those achieving a PASI score 90 did not receive the next 4 injections. This protocol was followed through week 36. Patients who did not reach a PASI score of 75 at 5 or more 4-week follow-ups could switch therapy. The primary outcomes were safety and efficacy.

Patients had a mean age of 39.43±12.42 years with a disease duration of 14.84±9.08 years. Overall, 10% of patients had psoriatic arthritis, 17.5% had comorbidities, and 10% had a prior biologic failure. The average PSAI score was 21.53±9.81, and BSA was 47.76%±22.84% at baseline.

After the first 4 injections, 96% of patients achieved a PASI score of 75, 88% a PASI score of 90, and 76% a PASI score of 100. At week 36, PASI scores of 75, 90, and 100 were maintained by 95%, 84%, and 68% of patients, respectively.

Overall, average PASI scores decreased to 3.71±4.24 at week 4 and were lowest at week 12 (mean, 0.59), but increased to 1.38±2.2 at week 36. Compared with baseline, PASI scores were significantly decreased at all follow-up assessments (all P <.0001).

Any adverse event was reported by 34.6% of patients; nasopharyngitis (7.4%), pruritus (6.2%), eczema (4.9%), urticaria (3.7%), and diarrhea (3.7%) were the most common adverse events.

Compared with the recommended regimen of 12 secukinumab injections, study patients received an average 7.96±1.14 secukinumab injections by week 36. Compared with the recommended protocol, these real-world observations correspond with a $2141 cost savings per patient during the 36-week treatment.

This study was limited by its open-label design, lack of a comparator cohort, and absence of randomization.

Study authors conclude, “Overall, the safety and efficacy of our tapering dose regimen were consistent with those of the previously recommended dose. […]This study demonstrates the feasibility of gradually increasing the dosing interval of secukinumab and may serve as a reference for biologic treatment experience, although a longer follow-up time and expanded sample sizes are necessary to investigate this possibility.”