Ustekinumab Successful Psoriasis Treatment for Patients with High BMI, Prior Treatment Failure

Guttate psoriasis
Guttate psoriasis
Effectiveness of UST 90 mg at 52 and 104 weeks in psoriasis and its efficacy in patients previously treated with anti-IL17 drugs were evaluated.

The efficacy of ustekinumab 90 mg (UST 90) for adult patients with psoriasis was supported by study data published in Dermatologic Therapy. During 2 years of follow-up, ustekinumab 90 mg (UST 90) was associated with significant reductions in psoriasis severity. This effect was observed even in patients with high body mass index (BMI) and patients who did not respond to earlier anti-interleukin (IL)-17 therapy.  

Investigators conducted an observational study of adult patients with moderate to severe psoriasis who received at least 2 subcutaneous injections of UST 90 from July 2017 to January 2019 at participating hospitals in Spain. Demographic and clinical data were extracted from patient medical records, including age, gender, weight, BMI, disease activity, psoriasis type, and comorbid conditions. The primary outcome was UST 90 effectiveness, assessed using the Psoriasis Area and Severity Index (PASI). The percentage of patients who achieved 75% (PASI 75) and 90% (PASI 90) reduction in initial severity scores was calculated. PASI was assessed at weeks 16, 52, and 104. Analyses were stratified by patient body weight (≥100 kg and <100 kg) and BMI (BMI <25, BMI 25-30, and BMI >30).

The study cohort comprised 141 adult patients with psoriasis, of whom 58% were men. Mean age at baseline was 48.6 years. The majority of patients (91.8%) began with 45 mg of UST and later increased dosage to 90 mg. The most common reasons for dosage increase were lack of cutaneous effectiveness (n=74; 52.9%), weight >100 kg (n=29; 20.7%), and to improve global efficiency (n=24; 17.1%). At 52 weeks, the percentage of patients with an absolute PASI <3 was 87.5%; the percentage with PASI <1 was 72.2%. The percentage of patients achieving PASI 75 or PASI 90 at weeks 16, 52, and 104 did not differ in weight strata. At 52 weeks, 36.9% and 34.0% of all patients had achieved PASI 75 and PASI 90, respectively. Results were maintained at 104 weeks. A total of 13 patients had received prior anti-IL-17 therapy, including secukinumab (n=10), ixekizumab (n=2), and brodalumab followed by secukinumab (n=1). These patients did not differ in terms of study outcomes from the rest of the cohort. UST 90 was stopped in 2.9% of patients due to lack of efficacy. No patient stopped treatment due to adverse events.

These data suggest that UST 90 is an effective psoriasis treatment in adult patients, independent of weight or BMI. UST 90 remained effective in patients with prior anti-IL-17 therapy failure. Study limitations include the retrospective design and use of multiple centers, across which measurement standards may have differed. However, these data provide support for UST 90 as “… an alternative treatment option not only for high BMI patients, but also to increase the cutaneous or articular efficacy of the drug in patients with normal BMI.”


Llamas-Velasco M, Baniandrés O, Rivera R, et al. A retrospective, observational multicenter study of 141 patients treated with ustekinumab 90 mg [published online May 24, 2020]. Dermatol Ther. doi: 10.1111/dth.13678