Ixekizumab, Brodalumab Exhibit Greater Cumulative Clinical Benefit for Patients With Psoriasis, Study Shows

Compared with other biologics approved for psoriasis treatment, excluding recently approved biologics, ixekizumab and brodalumab were shown to have greater cumulative clinical benefit for patients with psoriasis, according to study findings published in the Journal of the American Academy of Dermatology.

Study authors highlight that cumulative clinical improvement and speed of improvement are vital measurements of treatment efficacy in patients with psoriasis. “Although cumulative life course impairment is a theoretical construct referring to the burden of disease over a long period of time, evaluating the cumulative clinical benefit, even over the first 12 to 16 weeks of treatment, can improve understanding of the impact of treatment on the patient,” said the study authors.

To compare the cumulative clinical improvement and speed of improvement of biologics in the treatment of moderate to severe psoriasis, researchers conducted a systematic literature review measuring the cumulative benefits of biologics over 12 to 16 weeks. Eligible analyses included phase 3 trial data that measured Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 responses for biologics.

Cumulative clinical benefit was measured by area under the curve (AUC) and compared using the network meta-analysis (NMA) and Bayesian methodology on the relative probability of achieving percent of maximum AUC. The NMA analyses included a final data set of 28 articles that met measurement criteria.

Study results found that among biologics approved for psoriasis treatment, anti—interleukin (IL)-17 biologics consistently exhibited greater cumulative clinical benefits compared with anti–IL-23 and other biologics on PASI 75, PASI 90, and PASI 100 over the 12- or 16-week period.

According to 12-week data, the biologics ixekizumab and brodalumab both showed greater cumulative benefits for PASI 75, PASI 90, and PASI 100 than secukinumab, guselkumab, infliximab, adalimumab, ustekinumab, and etanercept. For studies that continued from week 12 to week 16, ixekizumab exhibited greater cumulative benefits than all other biologics in the 16-week analysis (secukinumab, guselkumab, ustekinumab, and adalimumab).

The median proportion of maximum AUC for PASI 75 in the 12-week data was 66% for ixekizumab 80 mg every 2 weeks (Q2W) and every 4 weeks (Q4W), compared with secukinumab 300 mg Q4W (57%), guselkumab 100 mg every 8 weeks (52%), adalimumab 40 mg Q2W (44%), and ustekinumab combined 45/90 mg doses every 12 weeks (42%).

Corresponding PASI 90 proportion of maximum AUC estimates were highest in ixekizumab (47%) compared with other biologics (secukinumab, 39%; guselkumab, 33%; adalimumab, 24%; ustekinumab, 23%), as were PASI 100 measurements (ixekizumab, 22%; secukinumab, 19%; guselkumab, 12%; ustekinumab, 10%; adalimumab, 7%).

Researchers note that the study’s findings may assist clinicians in differentiating among available treatment choices for patients with psoriasis. “Maximum cumulative clinical benefit percent achieved is a useful metric for capturing the speed and magnitude of clinical responses for psoriasis biologics,” said the study authors.

Reference

Warren RB, Gooderham M, Burge R, et al. Comparison of cumulative clinical benefits of biologics for the treatment of psoriasis over 16 weeks: results from a network meta-analysis [published online December 26, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.12.038.