Treating psoriasis patients with brodalumab achieves complete skin clearance more rapidly than ustekinumab. Although efficacy is obviously important, Dr Sandra Philipp (Charité-Universitätsmedizin Berlin, Germany) pointed out that patients rate the speed at which their disease improves as their most important treatment goal .
In the phase 3 AMAGINE-2 and AMAGINE-3 trials, Lebwohl et al. set out to describe and compare the onset of action, measured as the improvements in efficacy and quality of life, of brodalumab and ustekinumab in patients with moderate-to-severe psoriasis . This pooled analysis included data from patients who were randomised to constant ustekinumab (n=590) or brodalumab (n=339) 210 mg every 2 weeks. Efficacy was measured at number of patients with 75% or 100% improvement in the psoriasis area severity index (PASI) score, the attainments of an absolute PASI score of 2 or less, and achievement of a Dermatology Life Quality Index of 0 or 1.
Patients treated with brodalumab had a far more rapid response and a significantly higher proportion achieved PASI-75 already at week 2 compared with ustekinumab (OR 8.5, P<0.001). Even more impressive was that patients treated with brodalumab had a >15 higher chance of achieving complete skin clearance (PASI-100) already after 4 weeks of treatment compared with ustekinumab (OR 15.6, P<0.001). This trend still holds true at week 12, at which point twice as many patients have achieved PASI-100. The take-home message was that both drugs may be clinically effective, but the greatest difference between the treatments is at the earlier timepoints; particularly for complete clearance at week 4. These results confirm the significantly faster onset of action with brodalumab compared with ustekinumab in both clinical efficacy as well as patient-reported outcome measures.
- Philipp S, et al. P006, SPIN 2019, 25-27 April, Paris, France.
- Lebwohl MG, et al. N Engl J Med. 2015 Oct;373(14):1318-28.
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