Real world data from the use of secukinumab in the treatment of moderate‐to‐severe psoriasis, including scalp and palmoplantar psoriasis: A 104‐week clinical study

Abstract

Several clinical studies demonstrated the safety and efficacy of the interleukin‐17 inhibitor secukinumab in the systemic treatment of moderate‐to‐severe psoriasis, as well as psoriatic arthritis (PsA) in adults, whereas real‐world data is limited. A single‐center clinical study was performed to evaluate in real‐world practice the efficacy of secukinumab up to Week 104 of treatment in moderate‐to‐severe chronic plaque psoriasis, including scalp and palmoplantar involvement, according to Physician Global Assessment (PGA), PASI75/90/100 and scalp, and palmoplantar PGA. Drug survival, the safety profile of secukinumab, and patient's quality of life were also assessed during a 2‐year observation period. Out of 83 patients included, 56.3% were biologic‐naïve, and 94% had scalp, 25.3% palmoplantar, and 43.9% joint involvement. At Week 16, PASI75/PASI90/PASI100 were observed in 83.8/70.0/46.3%, respectively. Scalp and palmoplantar PGA were rapidly improved, with 98.7 and 95.5%, respectively, reaching clear/almost clear skin at Week 16. After 104 weeks, drug survival was 74.5%. A significant improvement of the quality of life was observed. Biologic‐naïve patients without coexisting PsA benefited the most. Real‐world data demonstrated secukinumab efficacious in chronic plaque psoriasis, including specific locations such as scalp and palmoplantar psoriasis with a safety profile similar to that in clinical trials.

Interleukin-17 cytokines: Effectors and targets in psoriasis—A breakthrough in understanding and treatment

“…Experimental and clinical evidence suggest that its dysregulation induces psoriasis. Thus, targeting the IL-23/IL-17 cytokine axis is a straightforward approach to treat psoriasis, as demonstrated in clinical trials as well as in real-world data (Rompoti et al, 2019). Nevertheless, the universe of treatment options in psoriasis is expanding, and manifold new targets are evolving.…”

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

“…Although secukinumab has been shown to be well tolerated and effective in treating patients with plaque psoriasis and PsA in multiple clinical trials (7-9,29-34) with up to 5-year follow up (35), randomized controlled trials are likely to enroll patient populations with more stringent inclusion/exclusion criteria and generally the study design allows a short-term observation compared to the real-world setting. A variety of real-world studies have been recently published: some of them analyzed secukinumab drug survival (36)(37)(38)(39), whereas others assessed its efficacy in psoriasis patient populations with peculiar features, or assessing its effectiveness as improvement of DLQI, BSA, PGA, and PASI scores (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Nevertheless, they reported favorable secukinumab safety and effectiveness in terms of mean reduction of PASI value over time, as patient rates achieving PASI 75, PASI 90, and PASI 100 responses at different timepoints, Investigator's Global Assessments or improvements in quality of life measures (11)(12)(13)(14)(15)(16)(17)(18)(19)22).…”

“…First, it is retrospective and can suffer from the effects of bias in the treatment and the rate of patients lost-to-follow up. Second, the observation period was limited to 52 weeks whereas other studies had longer observational periods (14,15). Third, relatively small cohort of patients was included (17,19,23).…”

“…Recently, some real-world studies describing the effectiveness and safety of secukinumab have been published, but only one study included data on the absolute residual PASI score (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Indeed, the effectiveness of antipsoriatic treatments is usually reported as the relative 75%, 90%, or 100% improvement from baseline on the Psoriasis Area Severity Index (PASI 75, PASI 90, PASI 100), though there is emerging interest in the evaluation of absolute PASI score reduction as a better benchmark of therapeutic response and the higher clinical relevance of the remaining absolute PASI score as therapeutic target (i.e.…”

Koebner phenomenon leading to the formation of new psoriatic lesions: evidences and mechanisms

“…It has been demonstrated that the mast cells along with neutrophils, but not T cells, are the predominant cells that contain IL-17 in the human skin [75] and IL-17 is one of the principal cytokines involved in the pathogenesis of psoriasis [76,77]. Accordingly, secukinumab (anti-IL-17 monoclonal antibody) has been approved as a first-line treatment for the management of moderate-to-severe plaque psoriasis [78] and as a second-line treatment for psoriatic arthritis. Moreover, other monoclonal antibodies targeting IL-17 including ixekizumab and brodalumab have also been approved by the FDA for the treatment of plaque psoriasis [79,80].…”