Secukinumab: a new management option for paediatric severe psoriasis

A new option for the management of paediatric severe chronic plaque psoriasis has just emerged with the approval of secukinumab by the European Commission (EC) for the treatment of paediatric moderate-to-severe chronic plaque psoriasis [1].

Until now, there have been limited treatment options for this condition; off-label regimens are frequently utilised with suboptimal results. Secukinumab is a fully human monoclonal antibody that inhibits interleukin (IL)-17, thus disrupting one of the key cytokines involved in the inflammatory pathway which leads to the formation of psoriatic plaques.

Prof. Christine Bodemer (Necker–Enfants Malades Hospital, France) reviewed the results to date of a phase 3, randomised, double-blind trial at the EADV Virtual Congress [2]. The 162 subjects between the age of 6 and 18 were randomised to 1 of 4 treatment arms: low-dose secukinumab, high-dose secukinumab, etanercept, or placebo. The primary outcome measure was dual: the percentage of participants demonstrating a 75% improvement from baseline in Psoriasis Area and Severity Index (PASI) score at week 12, and the percentage of participants who showed Investigator’s Global Assessment (IGA) modified 2011 response of 0 or 1 at week 12.

Both secukinumab treatment arms met this endpoint by week 12. Both high-dose and low-dose secukinumab continued to demonstrate high efficacy as demonstrated by PASI and IGA modified 2011 responses at week 52. Furthermore, improvements in the Children’s Dermatology Life Quality Index (CDLQI) scores were higher in both secukinumab groups than either the placebo or etanercept groups; the proportion of responders was also higher in the secukinumab groups. Safety profiles were deemed favourable in both groups.

The recommended dose of secukinumab for children up to 50 kg is 75 mg and a starting dose of 150 mg for those 50 kg or more (this dose can be increased to 300 mg, if needed). Both doses of secukinumab demonstrated high and sustained efficacy up to week 52 in clearing skin and improving quality of life with a favourable safety profile in paediatric patients with severe chronic plaque psoriasis.

 

1. 
   
   1. Petronelli M. Dermatology Times, 4 August 2020. [Accessed 31 October 2020].
   2. Bodemer C, et al. Secukinumab demonstrated high efficacy and a favorable safety profile in pediatric patients with severe chronic plaque psoriasis: One-year results. FC02.08, EADV Virtual Congres, 29-31 October 2020.

Posted on 2 November 202018 December 2020