Secukinumab proven safe, effective in moderate-to-severe plaque psoriasis
The first-in-class interleukin (IL)-17A monoclonal antibody secukinumab is a safe and effective treatment for moderate-to-severe plaque psoriasis, with efficacy rates similar to those found in its phase III studies and enduring up to a year from start of treatment.
A total of 158 patients were enrolled in this study. Of these, 57 percent, 83.5 percent, 89 percent and 78.5 percent achieved a Psoriasis Area and Severity Index (PASI) score improvement ≥75 percent over baseline at weeks 4, 12, 24 and 52, respectively. [J Am Acad Dermatol 2019;81:427-432]
Furthermore, PASI-90 was achieved in 27.8 percent, 62 percent, 64.6 percent and 63.2 percent of patients at weeks 4, 12, 24 and 52, respectively. Patients with a body mass index (BMI) <30 kg/cm2 and those without previous biologic therapy failures were more likely to achieve PASI-75 and PASI-90.
Responses were considerably worse for patients with higher BMIs (>30 kg/cm2) than nonobese individuals. This finding is consistent with that of a study by Bruin and colleagues, who showed that weight directly affects the pharmacokinetics of secukinumab. [J Clin Pharmacol 2017;57:876-885]
“This suggests that standard doses of biologic treatments might be insufficient in patients with large body surface areas and indicates the need to investigate alternative regimens with higher drug doses in obese patients,” researchers said.
Furthermore, an earlier study by Notario and colleagues, in which 136 Spanish patients with moderate-to-severe psoriasis treated with secukinumab were retrospectively analysed, also reported similar results. [J Dermatol Treat 2018;30:1-21]
Response rate in the current study, however, were higher than that in Notario’s, and this could have been driven by the higher adherence to treatment, the exclusion of patients treated with 150-mg secukinumab and the prospective bases of this investigation, according to researchers.
In another study, Schwensen and colleagues found PASI-75 and PASI-90 rates of 66.7 percent and 52.9 percent, respectively, at week 12 in 69 patient records obtained from a multicentric database. These findings are also similar to the current ones. [Dermatol Ther 2017;doi:10.1111/dth.12550]
No serious adverse events were recorded in the present study, and this is consistent with many other researches that have not found a significant risk associated with secukinumab. Longer prospective studies are warranted to confirm the long-term safety profile of secukinumab, according to researchers. [Rheumatology (Oxford) 2017;56:1993-2003]
The current multicentre, prospective, observational study recruited adult patients with moderate-to-severe plaque psoriasis from 12 hospitals in Spain from January to December 2016. Patients were treated with secukinumab and prospectively followed at 12-week intervals for 1 year.
This study was limited by its observational design and the unavailability of some IL-17 (ixekizumab and brodalumab) and IL-23 p19 antibodies (guselkumab and tildrakizumab) at the time of data collection. Time from onset of psoriasis was also not evaluated.
“Other studies have proposed that this variable is relevant,” researchers noted. “It has also been hypothesized that early targeted treatments might alter disease evolution.” [Expert Opin Biol Ther 2018;18:727-735]