Ixekizumab superior to secukinumab in real-world psoriasis study

In a small, real-world study, ixekizumab demonstrated superiority over secukinumab in the treatment of moderate-to-severe psoriasis over a follow-up period of 48 weeks. Ixekizumab also showed a more rapid onset of action.

Dr Caterina Cariti (University of Turin, Italy) pointed out that psoriasis is the most prevalent immune-mediated inflammatory skin disease [1]. Evidence from studies comparing different biologics for psoriasis in daily practice has been lacking. This was the rationale for Dr Cariti and her team to perform a study in a real practice setting, in which they compared the short-term and long-term efficacy, safety, and drug survival of the IL-17A inhibitors secukinumab and ixekizumab in patients with psoriasis treated in a dermatology unit in Turin, Italy.

In this non-randomised, observational study, psoriasis patients were enrolled retrospectively from October 2016 until April 2020 and followed until March 2021. Patient characteristics were typical for patients with moderate-to-severe psoriasis. About a third of the 445 participants were obese and the most frequent comorbidity was hypertension affecting almost 50% of participants. About a quarter of the participants in each group had 1 prior biologic failure.

At week 12, 24, and 48, significantly more patients in the ixekizumab group achieved an improvement in the Psoriasis Area and Severity Index of 90% (PASI 90) or complete clearance of their lesions (PASI 100; see Figure). “Ixekizumab was also more effective regarding the percentage of patients with residual PASI <3 at week 12 and the efficacy was well maintained over time,” Dr Cariti said. Biologic-naïve patients responded even better to both biologics, but again ixekizumab was superior at all timepoints. A similar outcome was shown in overweight patients.

Figure: PASI 90 and PASI 100 response at weeks 12, 24, and 48. Modified from [1]

Drug survival was similar in both groups: curves for ixekizumab and secukinumab were overlapping with a high retention rate for both. Of originally 445 participants, 441 (99%) were treated until week 12, 423 (95%) until week 24, and 387 (87%) until the end of the follow-up at week 48; 312 patients (70%) are still treated with the biologics, 171 on secukinumab (67%) and 141 (75%) continue therapy with ixekizumab. “In total, 133 patients (33%) discontinued treatment during the whole follow-up period, 85 of them (64%) were treated with secukinumab, 48 (36%) with ixekizumab,” Dr Cariti said. With regards to adverse events, no differences were observed between the drugs.

The researchers are planning to assess the IL-17 receptor blocker brodalumab in a similar setting.

1. 
   
   1. Cariti C. Comparison of secukinumab and ixekizumab in psoriasis: a real-life cohort study on efficacy and retention rate of 445 patients. FC08.03, EADV Congress 2021, 29 Sept–2 Oct.

 

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Posted on 18 November, 202118 November, 2021