Early Response to Biologics Linked With Stable Long-term Efficacy in Psoriasis

Early response to the biologics ixekizumab and ustekinumab was associated with positive long-term efficacy outcomes in the treatment of moderate-to-severe psoriasis, according to study findings published in the Journal of Drugs in Dermatology.

In the management of patients with psoriasis presenting with more severe disease, researchers noted that defining and predicting high levels of clinical response, as well as identifying which patients are at risk of not having such levels, is key in tailoring treatment plans.

Although baseline Psoriasis Area Severity Index (PASI) and body mass index scores have served as modifiable predictors of response, use of these metrics has not consistently determined response to biologic therapies.

“Preliminary data have shown early response to treatment is predictive of subsequent clinical improvement in patients with psoriasis,” they said.

“During ixekizumab treatment, patients who achieve at least a 40% improvement in PASI score (PASI 40) to at least a 50% improvement in PASI score (PASI 50) at weeks 4 and 6 often reach at least a 75% improvement in PASI score (PASI 75) at week 12 with a 90% predictability.”

Seeking to further assess how early response rates to biologic therapy may predict long-term response, researchers conducted a post-hoc analysis of the IXORA-S study that compared the safety and efficacy of the interleukin (IL)-17A inhibitor ixekizumab with the IL-12/23 inhibitor ustekinumab in patients with moderate-to-severe psoriasis.

In the analysis, early treatment response rates to ixekizumab and ustekinumab were evaluated by the percentage of patients treated who achieved PASI 50 at week 2 or 4. Early response rates to these therapies were then examined for stable long-term response, as measured by associations with maintaining complete (PASI 100) or almost complete (PASI 90) skin clearance at 80% of monthly visits during weeks 16-52 of treatment.

“Nonresponder imputation was used for missing PASI response status,” added the study authors.

In their findings, a numerically greater number of patients given ixekizumab achieved early response vs those treated with ustekinumab; these patients were significantly more likely to achieve a stable PASI 90 response (P < .0001) or PASI 100 response (P < .0001) than the ustekinumab group.

Moreover, all patients treated with either ixekizumab or ustekinumab who were identified as early responders were more likely to achieve a stable response of PASI 90 or 100 (Odds Ratio > 1).

“In patients with moderate-to-severe psoriasis treated with ixekizumab or ustekinumab, early response was a significant factor in maintaining stable complete or almost complete skin clearance,” concluded the study authors. “Therefore, rapid response is a clinically relevant factor to consider when optimizing individual therapeutic strategies.”

Reference

Augustin M, Gallo G, See K, et al. Early response is associated with stable long-term response in psoriasis patients receiving ixekizumab or ustekinumab. J Drugs Dermatol. 2022;21(2):122-126. doi: 10.36849/jdd.6063