Brodalumab Improves Skin Clearance, QOL vs Ustekinumab in Comorbid Psoriasis, PsA

Patients with concomitant psoriasis and psoriatic arthritis (PsA) were shown to be 3.1-fold more likely to achieve complete skin clearance when treated with brodalumab vs ustekinumab after 52 weeks, with further improvements reported for quality of life (QOL).

Patients with psoriasis, with and without concomitant psoriatic arthritis (PsA), were significantly more likely to report complete skin clearance and improved quality of life (QOL) when treated with brodalumab vs ustekinumab. The results were published in Dermatology.

In the treatment of PsA, early diagnosis and treatment is vital to reduce the risk of joint damage, disability, and comorbidities. Although biologics are effective in the treatment of moderate-to-severe psoriasis, in PsA, which typically occurs after the development of psoriasis, they have conversely been shown to be associated with failed sustained response in patients.

“The therapeutic goals for patients with PsA are to minimize disease activity, prevent disease progression, alleviate symptoms, improve QOL, and restore functional ability,” noted researchers.

In a prior post-hoc analysis of the 52-week phase 3 AMAGINE-2 and -3 studies, brodalumab, a fully human monoclonal antibody that binds with high affinity to the interleukin-17 receptor subunit A (IL-17RA), was shown to be effective in achieving and maintaining higher levels of complete skin clearance and QOL compared with ustekinumab in the treatment of patients with moderate-to-severe psoriasis. 

Conducting another post-hoc analysis of the AMAGINE-2 and -3 studies, researchers sought to examine the efficacy of brodalumab vs ustekinumab in patients with moderate-to-severe plaque psoriasis with and without concomitant PsA.

In the study, participants were assessed for complete skin clearance (100% improvement of Psoriasis Area and Severity Index [PASI 100]), improvement in symptom severity (Psoriasis Symptom Inventory [PSI] response), and QOL (Dermatology Life Quality Index [DLQI] score of 0/1) by concomitant PsA status.

Of the 929 patients with moderate-to-severe plaque psoriasis included in the analysis, concomitant PsA was present in 79 of 339 (23%) receiving brodalumab 210 mg and in 110 of 590 (19%) receiving ustekinumab.

After 52 weeks, patients with concomitant PsA were shown to be greater than 3 times more likely to report complete clearance with brodalumab vs ustekinumab (odds ratio [OR], 3.15; 95% CI, 1.52-6.55; P = .0015), as well as 2-fold more likely to achieve DLQI 0/1 (OR, 2.05; 95% CI, 1.07-3.90; P = .0277) and 3.4-fold more likely to report PSI less than or equal to 8 (OR, 3.42; 95% CI, 1.43-8.18; P = .0036).

Higher levels of significant improvement was also observed in patients without PsA who were treated with brodalumab vs ustekinumab for complete skin clearance (OR, 3.05; 95% CI, 2.19-4.26; P < .0001), DLQI 0/1 (OR, 1.83; 95% CI, 1.32-2.53; P = .0002), and PSI less than or equal to 8 (OR, 1.40; 95% CI, 1.01-1.95; P = .0434).

Cumulative incidence of patients achieving PASI 100 after 52 weeks was indicated to be significantly higher for brodalumab vs ustekinumab in patients with concomitant PsA (P = .0001) and in those without concomitant PsA (P < .0001).

Reference

Kokolakis G, Vadstrup K, Hansen JB, Carrascosa JM. Brodalumab is associated with high rates of complete clearance and quality of life improvement: A subgroup analysis of patients with psoriasis and concomitant psoriatic arthritis. Dermatology. Published online November 25, 2021. doi:10.1159/000520290