Secukinumab Associated With Greater PASI 2 or Lower Achievement vs Ustekinumab in Psoriasis

The effectiveness of ustekinumab and secukinumab in the treatment of psoriasis was assessed.

Treatment with secukinumab was associated with a greater likelihood of achieving a PASI of 2 or lower after 12 months compared with treatment with ustekinumab in patients with psoriasis, according to study data published in JAMA Dermatology.

Data for this study were obtained from the longitudinal British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR), which included patients with moderate to severe psoriasis living in the United Kingdom and Republic of Ireland.

A total of 1231 adult patients with chronic plaque psoriasis and 1 or more recorded PASI scores of 12 or higherbefore starting secukinumab (n=314) or ustekinumab (n=917) were included in this analysis. The study’s primary outcomes were the risk ratio (RR) and risk difference (RD) for achievement of PASI of 2 or lower after 1 year treatment with secukinumab vs ustekinumab.

In the study population, treatment with secukinumab was superior to treatment with ustekinumab in all analyses. The superiority held true except under the nonresponders imputation method in the percentage of patients who achieved PASI of 2 or lower (propensity score [PS]-weighted complete case analysis: risk ratio, 1.28; 95% CI, 1.06-1.55; risk difference, 11.9%; 95% CI, 1.6-22.1). Aside from the nonresponder imputation method, all analyses reached regulatory agreement in PS-matching and -weighted analyses.

A limitation of this study included the substantial amount of missing data for the primary outcome, as only 45% of the study cohort had a recorded PASI at 12 months aftertreatment.

The investigators indicate that the findings from this analysis revealed “a gap between the efficacy of biologic therapies in an idealized trial setting and the effectiveness of biologic therapies in the real-world clinical setting in the treatment of psoriasis.”

Although the researchers did not provide a firm conclusion as to how these findings could be relevant to clinical care, they suggest “the use of this target trial framework in future comparative effectiveness studies that use data from BADBIR.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Yiu ZZN, Mason KJ, Hampton PJ, et al. Randomized trial replication using observational data for comparative effectiveness of secukinumab and ustekinumab in psoriasis: A study from the British Association of Dermatologists Biologics and Immunomodulators Register. Published online December 2, 2020. JAMA Dermatol. doi:10.1001/jamadermatol.2020.4202