Improvement in impact of genital psoriasis on sexual activity with use of ixekizumab

Genital lesions are not rare in psoriasis; however, often overlooked is their severe impact on the patient’s QoL [2,3]. Psoriasis in this location is seen as especially embarrassing and is, moreover, often mistaken for a sexually transmitted disease [4].

A substantial proportion of patients experiences increased problems after sexual activity. In an observational, multicentre study of 354 participants, 87% reported itch, 39% pain, 42% dyspareunia, 32% a worsening of their genital psoriasis after intercourse, and 43% a decreased frequency of intercourse [5].

The current Phase 3b randomised controlled trial by Dr Jennifer Cather of the Aesthetics Center in Dallas and her colleagues therefore investigated whether treatment of genital psoriasis with the IL-17 blocker ixekizumab has a positive influence on the sexual activity of patients [6]. 149 participants were randomised to receive either a placebo over 12 weeks or 80 mg of ixekizumab subcutaneous every two weeks after a starting dose of 160 mg. The study subjects all had moderate-to-severe genital psoriasis.

Its influence on sexual activity was evaluated by extracting specific questions from the Genital Psoriasis Sexual Frequency Questionnaire. At 12 weeks, 92% of patients treated with ixekizumab compared to 56.8% of patients treated with placebo reported no (0) or little (1) sexual difficulties caused by skin symptoms (P<0.001; see Figure). 78.4% of patients treated with ixekizumab, compared to 21.4% of patients treated with placebo (P<0.001), reported the frequency of sexual activity was either never (0) or rarely (1) limited by genital psoriasis. Ixekizumab was superior to placebo as early as Week 1 regarding the limitations on the frequency of sexual activity due to genital psoriasis (P<0.05) and Week 2 for the sexual difficulties caused by skin symptoms (P<0.001). A greater number of patients under ixekizumab stated considerably more often that they never or rarely avoided sexual activity owing to their genital psoriasis at Week 12 (76.7% IXE vs. 25.7 placebo, P<0.001).

Figure: Proportion of patients treated either with ixekizumab or placebo whose skin did not cause any sexual difficulties [6].



The ixekizumab group also experienced a markedly reduced worsening of local psoriasis symptoms during or following sexual activity at Weeks 2, 4 and 8. The most common (greater than 4%) adverse events observed in patients treated with ixekizumab in this study were upper respiratory tract infections, injection-site reactions, headache, oropharyngeal pain and pruritus. The safety outcomes were consistent with the overall safety profile of the agent in previous clinical trials.

2. Ryan. et al. J Am Acad Dermatol. 2015;72:978–83.
3. Meeuwis. et al. Acta Derm Venereol 2015;95:211–6.
4. Czuczwar, P. et al. Ginekol Pol 2016;87:717–721.
5. Ryan. et al. J Am Acad Dermatol. 2015;72:978–83.
6. Cather, JC. et al. P5935, AAD Annual Meeting, February 16–20 2018.



Posted on 21 December, 201825 March, 2021