Secukinumab Dosing Regimen Influences Plaque Psoriasis Response in Heavier Patients

The efficacay, safety, and tolerability of secukinumab 300 biweekly vs very 4 weeks in heavier patients with psoriasis is evaluated.

Secukinumab 300 mg administered biweekly (Q2W) is superior to dosing every 4 weeks (Q4W) in the treatment of moderate to severe plaque psoriasis in individuals weighing 90 kg or more, according to study findings published in the British Journal of Dermatology.

This multicenter, double-blind trial included 320 individuals weighing 90 kg or more who had moderate to severe plaque psoriasis, all of whom were randomly assigned to secukinumab 300 mg Q2W (n=160) or Q4W (n=160). The trial was divided into 4 periods: screening (≤4 weeks), treatment period 1 (16 weeks), treatment period 2 (36 weeks), and a follow-up period posttreatment (8 weeks). At week 16, nonresponders in the Q4W group either remained in the group (n=40) or switched to the Q2W group (n=31).

The study’s primary endpoint was the comparative Psoriasis Area and Severity Index (PASI) 90 response at week 16 between the 2 groups. Secondary endpoints included clinical tolerability, safety, and the percentage of participants at week 16 achieving an Investigator’s Global Assessment (IGA) Scale score of 0 or 1. Logistic regression was used for primary analysis, with baseline body weight, PASI score, and treatment group as explanatory variables.

At week 16, significantly higher PASI 90 responses were observed in the Q2W group (73.2%) vs Q4W (55.5%), resulting in an odds ratio (OR) of 2.3 (95% CI, 1.4-3.8) and a treatment difference of 17.7% (P =.0003). At 1 year, the Q2W arm (n=165) maintained higher PASI 75/90/100 and IGA 0 or 1 responses compared with Q4W (n=83), with PASI 75 of 88.9% vs 74.8%, PASI 90 of 76.4% vs. 52.4%, PASI 100 of 46.7% vs. 27.3%, and IGA 0 or 1 of 75.9% vs. 55.6%. Q4W nonresponders who switched to the Q2W group at week 16 showed better responses at week 32 compared with those who remained (PASI 90, 38.7% vs 16.5%; P =.0439). Safety results were similar across groups and were consistent with the established safety profile of secukinumab.

The study researchers concluded, “Secukinumab 300 mg Q2W demonstrated superior and sustained efficacy compared [with] secukinumab 300 mg Q4W in moderate to severe plaque psoriasis patients weighing ≥90 kg.” They further indicated that “the safety profile in both dosing regimens was similar and consistent with that previously established,” which further supports “the use of an alternative treatment regimen for heavier psoriasis patients (≥90 kg) with the aim of rapidly controlling their disease and achieving PASI 90 responses.”

Disclosure: This clinical trial was supported by Novartis. Please see the original reference for a full list of authors’ disclosures.


Augustin M, Reich K, Yamauchi P, et al. Secukinumab dosing every two weeks demonstrated superior efficacy compared with dosing every four weeks in patients with psoriasis weighing 90 kg or more: results of a randomised controlled trial [published online January 4, 2022]. Br J Dermatol. doi:10.1111/bjd.20971