Secukinumab Effective for Treatment of Refractory Plaque Psoriasis

Plaque psoriasis
Plaque psoriasis
Human anti-interleukin-17A monoclonal antibody secukinumab has demonstrated utility for the treatment of patients with chronic plaque psoriasis.

The use of the human anti-interleukin-17A monoclonal antibody secukinumab has demonstrated utility for the treatment of chronic plaque psoriasis, according to the results of a single-center, retrospective, observational cohort study that was conducted in London, United Kingdom. Findings from the analysis were published in the Journal of the European Academy of Dermatology and Venereology.1

The investigators sought to evaluate the real-world clinical effectiveness of secukinumab in patients attending a specialist psoriasis clinic.2 All patients who initiated secukinumab therapy between July 2015 and March 2016 were identified from a pharmacy database. The researchers extracted 12-week and 24-week data from clinical notes. Use of overlap therapy, which denoted medication coprescribed from secukinumab initiation, and rescue therapy, defined as medication prescribed postcommencement, was included in the analysis. Clinical response was described as achieving ≥75% reduction in the Psoriasis Area and Severity Index (PASI 75) at 24 weeks.

A total of 35 patients met study eligibility criteria. The mean participant age was 48.6 years; 69% of the patients were men. The mean patient weight was 92.5 kg; 54% of the patients had a history of psoriatic arthritis. All of the participants had received biologic medications previously, with 22.8% having received 1 prior biologic agent, 22.8% having received 2 biologic agents, and 54.3% having received ≥3 biologic agents. Mean baseline PASI was 15.5; mean Dermatology Life Quality Index was 17.24.

At 24 weeks, 31.43% (11 of 35) of participants achieved PASI 75. The mean decrease in PASI from baseline was 7.92 at 24 weeks. Overall, 20% (7 of 35) of patients attained an absolute PASI <2 at 24 weeks. Mean reduction in Dermatology Life Quality Index from baseline was 8.71 at 24 weeks.

No significant association was observed between response to therapy and age, gender, prior biologic exposure, or presence of psoriatic arthritis. Response rates among patients receiving 1, 2, 3, or 4 prior biologic agents were 37.5%, 25%, 38.5%, and 50%, respectively. A total of 26 patients had been treated previously with ustekinumab, with 17 of 23 patients failing to achieve ∆PASI 75 on ustekinumab at 16 weeks. Among these 17 individuals, 5 attained ∆PASI 75 on secukinumab at 24 weeks.

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Overall, 28.6% (10 of 35) of participants experienced new medical problems on treatment, with none of them deemed serious in nature. None of the patients discontinued therapy.

The investigators concluded that the data from this study suggest a discrepancy between the clinical effectiveness of secukinumab in trials and the outcomes reported in practice. This is most likely because of the contrast in trial vs real-world patient populations, both with respect to comorbidities and treatment histories. The data support the use of secukinumab for chronic plaque psoriasis that fails to respond to ustekinumab. 

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1. Sears AV, Szlumper C, Liu KW, Smith CH, Barker JNWN, Pink AE. Clinical outcomes in patients on secukinumab (Cosentyx®) within a specialist psoriasis clinic: a single centre, retrospective cohort study [published online September 10, 2018]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.15245

2. Smith CH, Jabbar-Lopez ZK, Yiu ZZ, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol. 2017;177(3):628-636.