Real-world Data Confirm Early Efficacy of Anti-IL-17A Inhibitors for Psoriasis

Real-world data are supporting findings from randomized controlled trials of anti-interleukin (IL)-17A inhibitors in psoriasis, showing that the treatment class achieves favorable efficacy and early onset of skin clearance in these patients.

The new findings come from nearly 2000 patients enrolled in the Psoriasis Study of Health Outcomes (PSoHO), a 3-year observational cohort study. Anti-IL-17A treatment—ixekizumab and secukinumab—consistently improved outcomes across primary and secondary endpoints compared with all other approved biologics. Notably, the researchers also found differences between ixekizumab and secukinumab.

“In PSoHO, the anti-IL-17A cohort outperformed the other biologics cohort on all clinical outcome measures at Week 12, confirming their general short-term efficacy and rapid onset of action in the real-world setting,” commented the researchers. “The effectiveness analyses, however, also illustrate the importance of considering treatments individually, rather than only grouped together by class.”

All patients included in the ongoing PSoHO study have chronic moderate-to-severe plaque psoriasis and are initiating or switching to a new biologic. Patients included in this analysis came from 240 sites across 23 countries.

At 12 weeks of treatment, patients receiving anti-IL-17A treatment were 1.9 times more likely to achieve Psoriasis Area and Severity Index (PASI 90) and/or static Physician Global Assessment (sPGA) 0/1, the study’s primary outcome, than patients receiving other biologics. Compared with the 58.6% of patients receiving other biologics, 71.4% of patients receiving anti—IL-717A treatment achieved PASI 90 and/or sPGA 0/1.

A greater proportion of patients receiving anti-IL-717A treatment were able to achieve PASI 75/90/100, absolute pASI scores of ≤5/≤2/≤1, and Dermatology Life Quality Index (DLQI) (0,1) at a higher rate than patients receiving other biologics. The researchers noted that odds ratios were higher than 2 for each of these secondary outcomes.

Secondary outcomes of the study included also efficacy comparisons between ixekizumab and other biologics. Ixekizumab consistently yielded higher response rates for achieving the primary outcome at week 12, with response rates that were approximately 7%-9% higher than those of risankizumab, brodalumab, and secukinumab; and response rates that were up to 20% higher than those of ustekinumab, adalimumab, and guselkumab.

“In the absence of a head-to-head randomized clinical trial of SEC vs. IXE, PSoHO provides a direct comparison of the two anti-IL-17A biologics for the first time, showing higher response rates for IXE vs. SEC for the primary endpoint, PASI 75/90/100, as well as absolute PASI ≤5, ≤2, ≤1,” explained the researchers. “Conversely, BROD, a biologic blocking the subunit A of the IL-17 receptor (IL-17RA) and thus preventing the activity of numerous IL-17 cytokines apart from IL-17A, shows numerically, but not significantly higher PASI 90 and PASI 100 response rates than IXE at Week 12.”

Patients receiving brodalumab, ixekizumab, and secukinumab reported no impact of disease of quality of life at week 12, with the DLQI (0,1).

Due to the nature of the PSoHO study, the researchers noted that they were unable to collect comparisons on adverse events between treatments.

Reference

Pinter A, Puig L, Schäkel K, et al. Comparative effectiveness of biologics in clinical practice: week 12 primary outcomes from an international observational psoriasis study of health outcomes (PSoHO). J Eur Acad Dermatol Venereol. Published online June 29, 2022. doi: 10.1111/jdv.18376