Latest news with #brodalumab
Medscape
19-06-2025
- Health
- Medscape
Can Dose Spacing of IL-17i Maintain Efficacy in Psoriasis?
Dose spacing of interleukin-17 (IL-17) inhibitors maintained therapeutic efficacy in patients with stable psoriasis, with no substantial differences observed between secukinumab and brodalumab and acceptable survival of the dose-spacing regimen for up to 12 months. METHODOLOGY: This retrospective cohort study analysed the effectiveness and survival of patients with psoriasis undergoing therapeutic biologic dose spacing of secukinumab or brodalumab. The analysis included 80 patients; 38.75% of them received secukinumab and 61.25% received brodalumab. Dose spacing was defined as extending secukinumab dosing to every 6 weeks and brodalumab to every 3 weeks after induction. All patients underwent 50% dose spacing of the approved range after a mean treatment duration of 35 months. Researchers monitored mean Psoriasis Area Severity Index (PASI) scores, PASI100, PASI90, and PASI ≤ 1. The mean follow-up duration under the dose-spacing regimen was 6.7 months. TAKEAWAY: The mean PASI value was 0.7 after 3 months of dose spacing and 0.1 after 12 months. No significant differences in mean PASI scores were observed between secukinumab and brodalumab at any timepoint after dose spacing. PASI100 achievement was 91.25% at dose-spacing initiation and remained stable throughout the following year; 99% of patients achieved PASI90 and 100% achieved PASI ≤ 1 at dose-spacing initiation, and both rates were maintained at 12 months. The 12-month drug survival rate for the dose-spacing regimen was 66.1%, with 25% of patients returning to standard dosage and 66.7% of these cases regaining PASI100. Secukinumab demonstrated higher drug survival after dose spacing than brodalumab (78.3% vs 58.9%). IN PRACTICE: "No significant differences in effectiveness were found between secukinumab and brodalumab in patients undergoing a D-S [dose-spacing] regimen. Overall, dose de-escalation of IL-17 inhibitors in patients with psoriasis who have achieved a stable response seems an effective therapeutic strategy, even if 2 of 5 patients returned to the original regimen after 1 year. When coming back to the standard regimen after D-S, PASI was regained by two-thirds of patients after 6 months," the authors of the study wrote. SOURCE: This study was led by Luca Mastorino, Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. It was published online on June 12, 2025, in Clinical and Experimental Dermatology . LIMITATIONS: The study's real-life design and retrospective nature may have introduced potential biases. The relatively small sample size could have affected the generalisability of the findings. The analysis of observed cases may have affected the interpretation of long-term outcomes. DISCLOSURES: This study did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors reported having no relevant conflicts of interest.
Medscape
05-06-2025
- Health
- Medscape
IL-23 Inhibitors Show Highest Drug Survival in Psoriasis
Interleukin (IL)-23p19 inhibitors guselkumab and risankizumab demonstrated the highest drug survival for effectiveness and safety comparable with ustekinumab over 2 years, exceeding that of all other biologics. IL-17 receptor inhibitor brodalumab showed comparable effectiveness and safety with adalimumab and secukinumab. METHODOLOGY: Researchers conducted a cohort study using data from the British Association of Dermatologists Biologics and Immunomodulators Register from November 2007 to June 2023 and compared the drug survival of all current commonly used biologics in patients with chronic plaque psoriasis (median age at therapy initiation, 48 years). The analysis included 19,034 treatment courses across the following biologics: Tumour necrosis factor-alpha inhibitor adalimumab (n = 6815), IL-12/23p40 inhibitor ustekinumab (n = 5639), IL-17A inhibitors secukinumab (n = 3051) and ixekizumab (n = 1072), IL-17 receptor inhibitor brodalumab (n = 367), and IL-23p19 inhibitors guselkumab (n = 1258) and risankizumab (n = 832). Multivariable flexible parametric models assessed drug survival, with discontinuation due to ineffectiveness and adverse effects reported separately. Researchers also calculated the restricted mean survival time (RMST) at 2 years for each biologic and the difference in RMST between all comparator biologics. The overall median follow-up duration was 2.3 years. TAKEAWAY: Guselkumab and risankizumab demonstrated the highest adjusted survival time for effectiveness (RMST, 1.93 years for both; 95% CI, 1.91-1.95 and 1.90-1.96 years, respectively). Risankizumab showed the highest survival for safety (1.94 years; 95% CI, 1.92-1.96 years), followed by guselkumab (1.92 years; 95% CI, 1.90-1.94 years) and ustekinumab (1.92 years; 95% CI, 1.91-1.93 years). Brodalumab exhibited a lower adjusted survival time for effectiveness (1.75 years; 95% CI, 1.69-1.81 years) than most biologics except secukinumab and adalimumab and lower drug survival for safety than all biologics except the IL-17A inhibitors and adalimumab. Among the IL-17A inhibitors, secukinumab exhibited significantly lower adjusted drug survival than ixekizumab for effectiveness but had a significantly higher safety profile. Prior exposure to biologics was associated with a decline in survival, with significantly larger reductions observed for IL-17 inhibitors. IN PRACTICE: "Drug survival is high with IL23p19 inhibitors. People with psoriasis persist with IL23p19 inhibitors up to an estimated 21 weeks more for effectiveness and 13 weeks more for safety compared with other biologics over a 2-year period on average," the authors wrote. "This evidence on the absolute difference in time persisted on biologic may help clinicians and patients make an informed decision on choosing the right biologic, including differentiating between different classes of biologics based on the patient's history of having PsA [psoriatic arthritis] or not, their treatment history, and whether they prioritize treatment longevity," they added. SOURCE: This study was led by Leila Motedayen Aval, The University of Manchester, The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, England. It was published online on May 29, 2025, in the Journal of the European Academy of Dermatology and Venereology . LIMITATIONS: This study was limited by missing data for newer biologics, particularly IL-17A inhibitors and IL-23p19 inhibitors, and shorter follow-up periods for newer treatments. Residual selection bias may have been present. Additionally, researchers could not evaluate dosing regimens due to missing data for over 50% of dosing frequency information for secukinumab, and results may not be generalisable beyond the UK and Republic of Ireland healthcare systems. DISCLOSURES: The British Association of Dermatologists Biologic Register Ltd receives income from AbbVie, Almirall, Eli Lilly, J&J, Leo Pharma, Novartis, Samsung Bioepis, UCB, BI, and BMS for providing pharmacovigilance services. This research was supported by the National Institute for Health and Care Research Manchester, Guy's and St Thomas' and Newcastle's Biomedical Research Centres. Several authors reported receiving grants or personal fees and having other ties with various sources.
