Secukinumab for Severe Psoriasis Relapse After Brodalumab Discontinuation

Treatment with the interleukin-17A (IL17A) inhibitor secukinumab is effective for severe forms of relapse and rebound of psoriasis following abrupt discontinuation of brodalumab (an IL17R inhibitor), according to the results of a monocentric, retrospective study conducted in Nice, France, and published in the Journal of the American Academy of Dermatology.

The study was conducted between June 2016 and June 2017. Patients who were treated with secukinumab following a relapse of moderate to severe plaque psoriasis (ie, Psoriasis Area and Severity Index [PASI] of ≥12) or a severe form of psoriasis (pustular or erythrodermic) after brodalumab discontinuation were included in the study.

The abrupt discontinuation of brodalumab occurred in June 2015 because of the interruption of the drug development program. The primary efficacy outcome was PASI. Secondary efficacy outcomes included body surface area and American College of Rheumatology response criteria to evaluate functional disability in patients with psoriatic arthritis.

Of 139 patients treated previously with brodalumab, 30 received secukinumab and were included in the analysis. The other 119 patients were treated successfully with methotrexate, antitumor necrosis factor inhibitors, or ustekinumab. Among brodalumab-treated patients, the mean duration of therapy was 160 weeks (range, 24 to 240 weeks). All patients had PASI 90 prior to drug discontinuation. Mean duration of brodalumab discontinuation and relapse of psoriasis was 9 weeks (range, 2 to 24 weeks).

The severity of psoriasis following discontinuation of brodalumab was greater than at baseline. The mean time between brodalumab discontinuation and secukinumab therapy was 10 months (range, 2 to 12 months).

Mean PASI decreased from 36.9 (range, 18 to 68.4) to 0.74 (range, 0 to 9.6 months) 9 weeks after initiation of secukinumab therapy and to 0.23 (range, 0 to 5) 36 weeks after secukinumab initiation. At 9 weeks, based on American College of Rheumatology criteria, all patients attained “psoriatic arthritis clear.” Adverse events associated with secukinumab included oral candidiasis in 4 patients and upper respiratory tract infection in 1 patient.

The investigators concluded that the IL17A inhibitor secukinumab is effective for the treatment of severe forms of psoriasis relapse and rebound following abrupt discontinuation of the IL17R inhibitor brodalumab.

Reference

Khemis A, Kelati A, Montaudié H, Lacour J-P, Passeron T. Successful treatment of severe psoriasis relapse with secukinumab(IL17 A inhibitor) after abrupt brodalumab (IL17 receptor inhibitor) discontinuation: a retrospective study evaluating long term efficacy and safety [published online March 26, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.027