<p>Brodalumab for the treatment of moderate-to-severe psoriasis: case series and literature review</p>

Abstract

Brodalumab, a recombinant fully human monoclonal immunoglobulin IgG2 antibody with high affinity to human interleukin (IL)-17RA, is approved for the treatment of moderate-to-severe plaque psoriasis. In controlled clinical trials, brodalumab 210 mg administered by subcutaneous injection at weeks 0, 1, and 2, then 210 mg every 2 weeks, produced a rapid onset and sustained clinical response. Consistently, >80% of patients achieved PASI-75 and efficacy was maintained for >2 years. The benefits are apparent soon after the start of therapy and are maintained in the long term. Such results, from the reviewed literature, support the findings from 4 'real world' cases in mainstream clinical practice which are reported here. Psoriatic plaques, including on the scalp, nails, soles and palms, were largely resolved, and quality of life improved markedly. Therapeutic success was achieved in patients naïve to biologics (2 cases) and in those responding inadequately to other biologics (2 cases). The high affinity of brodalumab to human IL-17RA blocks the biological activities of the pro-inflammatory cytokines IL-17A, IL-17C, IL-17E, IL-17F, and IL-17A/F heterodimer, resulting in inhibition of the inflammation and clinical symptoms associated with psoriasis. This mechanism of blocking multiple IL-17 family cytokines differs from that of other available biologics which selectively target some parts of the Th-17 axis and may account for the effectiveness of brodalumab in patients poorly responsive to other biologics, a feature which has also been shown where subgroup analysis has been undertaken in clinical trials. The drug is well tolerated during the normal 12-week induction phase and with prolonged treatment (52 to 120 weeks), as it was in the current case series.

Brodalumab for the treatment of moderate‐to‐severe plaque‐type psoriasis: a real‐life, retrospective 24‐week experience

“…Similarly, a case series of 6 patients reported rapid reductions in PASI and DLQI scores by week 4, which were durable through week 52 27 . Moreover, significant improvement or complete clearance of lesions was achieved within 2–6 weeks by four patients in a separate case series 24 . In our study, absolute PASI response rates are consistent with the pattern shown by the PASI scores, highlighting a fast and sustained onset of action.…”

“…Due to its rapid onset of action, efficacy and safety profile, brodalumab is a valuable therapeutic option for patients with psoriasis who require lifelong treatment. However, real‐life studies on brodalumab‐treated patients are limited to case reports or studies with small numbers of participants 22‐28 …”

Therapeutic update of biologics and small molecules for scalp psoriasis: a systematic review

“…week for the first 3 weeks, and then every 2 weeks): a complete clearance or significant improvement was reached within the first 6 weeks of treatment. 34…”

Small Molecules and Biologics in the Treatment of Nail Psoriasis

“…Psoriatic plaques of the scalp, nails, soles, and palms were rapidly treated, while QoL improved for all 4 patients with long-term sustainable results. The 2 patients with PsA also experienced joint pain relief during the treatment [55]. Skin Appendage Disord 2020;6:134-141 DOI: 10.1159/000507298…”