News · March 11, 2019

AAD 2019: Anti-Interleukin Agents Show Greatest Efficacy in Meta-Analyses of Treatments for Plaque Psoriasis

Risankizumab emerges as the most effective in analyses sponsored by the drug's manufacturer

PracticeUpdate Editorial Team

March 3, 2019—Washington, DC— Anti-interleukin (IL) agents may have the edge on other classes of drugs approved for the clearance of moderate-to-severe plaque psoriasis, according to meta-analyses indirectly comparing 13 different agents. The findings were presented here at the 2019 American Academy of Dermatology Annual Meeting, which took place from March 1 to 5.

"The clinical benefits of novel treatments for moderate-to-severe psoriasis have been well-established, but wide variations exist in patient response across different therapies," the study authors wrote in their presentation. "In the absence of head-to-head randomized trials across the entire set of comparators, meta-analyses combining data from multiple studies to assess comparative efficacy are needed."

Results of such meta-analyses were presented by April W. Armstrong, MD, from the Keck School of Medicine at the University of California, Los Angeles.

Dr. Armstrong and colleagues conducted a systematic literature review of 83 phase II or III randomized controlled trials of treatments and dosages licensed by the European Medicines Agency for adult patients with moderate to severe psoriasis. Treatments assessed were: 1) anti-TNF agents (adalimumab, certolizumab pegol, etanercept, and infliximab); 2) anti-IL agents (brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab); 3) anti-PDE4 agents (apremilast); and 4) fumaric acid esters (dimethyl fumarate).

Outcomes compared were the probabilities of achieving a 90% or 100% reduction in Psoriasis Area and Severity Index from baseline (PASI 90/100) at the end of the primary response period of included trials (10 – 16 weeks from baseline) and at the end of the maintenance period (44 – 60 weeks from baseline).

Overall, 60 trials were included in a network meta-analysis of results at weeks 10 to 16. This analysis revealed that risankizumab, ixekizumab, brodalumab, and guselkumab had the highest PASI 90/100 rates at weeks 10 to 16 among assessed treatments, compared with etanercept, adalimumab, ustekinumab, certolizumab pegol, tildrakizumab, dimethyl fumarate, and apremilast. Risankizumab, ixekizumab, and brodalumab also had significantly higher PASI 90/100 rates than secukinumab and infliximab (P < .05). There were no statistically significant differences among risankizumab, ixekizumab, brodalumab, and guselkumab.

A meta-analysis of results at weeks 44 to 60 included a total of 23 trials on 10 treatments. Long-term data were only reported for the 50 mg biweekly dose for etanercept, and PASI 100 was not reported for apremilast, etanercept, and infliximab.

In this analysis, risankizumab, brodalumab, ixekizumab, guselkumab, and secukinumab had the highest estimated PASI 90/100 response rates, with PASI 90/100 ratings significantly higher than etanercept, infliximab, adalimumab, ustekinumab, and apremilast. Among the five biologics with the greatest activity, risankizumab had a significantly higher PASI 90 rate than ixekizumab and secukinumab. In addition, risankizumab, brodalumab, and ixekizumab had significantly higher PASI 100 rates than secukinumab, while risankizumab and ixekizumab had significantly higher PASI 100 rates than guselkumab (P < .05)

The authors concluded in their presentation that, "over the primary response period, risankizumab, ixekizumab, brodalumab, and guselkumab were associated with the highest estimated PASI response rates. Over the long-term maintenance period, there were some notable differences, with risankizumab having significantly higher PASI 90 rates than secukinumab and ixekizumab and significantly higher PASI 100 rates than guselkumab."

This study received support from AbbVie, manufacturers of risankizumab.

http://www.practiceupdate.com/content/aad-2019-anti-interleukin-agents-show-greatest-efficacy-in-meta-analyses-of-treatments-for-plaque-psoriasis/80888

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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