Rapidos y furiosos en Psoriasis

Published in Dermatology

Journal Scan / Review · October 30, 2019

Onset of Action for Interleukin-17 and Interleukin-23 Inhibitors for Psoriasis

Journal of the European Academy of Dermatology and Venereology: JEADV

TAKE-HOME MESSAGE

• This systematic review of 27 publications assessed the time to onset of action for interleukin-17 and interleukin-23 agents in the treatment of psoriasis reported in the literature.

• Overall, brodalumab and ixekizumab demonstrated the fastest onset of action. These data may be particularly useful when rapid onset of action is essential in the setting of patients with severe or acute flaring psoriasis.

– InYoung Kim, MD, PhD

Written by

 

 

James F Libecco MD

Patients have demonstrated that the speed of clearance is an important factor in their treatment. Time to clearance is hard to observe in clinical practice because dermatologists do not get to see patients back as frequently as the visits occur in a clinical trial. At a 3- or 6-month follow-up, we may miss the nuances between products, and, in a crowded market, these small differences may be differentiators. This review extracts comparative data from clinical trials for IL-17 and IL-23 inhibitors and pulls in prior completed studies on traditional agents, TNF inhibitors, forgotten therapies like alefacept, and IL-12/23 inhibitors. There are notable differences in time to reach PASI 75, 90, and 100 among agents, with a bias toward IL-17 inhibitors (brodalumab and ixekizumab, in particular) achieving the fastest clearance to each tier.

In clinical practice, this may have relevance when treating someone with a distressing or severe flare of psoriasis that requires immediacy of effect. The time to one-quarter of patients achieving PASI 75 on brodalumab at 2.1 weeks or ixekizumab at 2.2 weeks is contrasted to the time with infliximab at 3.5 weeks or cyclosporine at 6.0 weeks. I choose these two medications as comparators as they are seemingly held as the flag bearer for fast response; but, when objectively measured, fall far short of the response time with an IL-17 inhibitor.

Obviously, speed isn't the only factor of relevance, but it is certainly an important feature, especially when combined with the high percentage of patients achieving PASI 90 and 100 response rates with IL-17 inhibitors. I certainly still have a place for methotrexate, cyclosporine, IL-23 inhibitors, and TNF inhibitors in my practice, but these data help guide my choice, especially when speed is of the essence.

Abstract 

Several novel biologics are available or in development for moderate-to-severe plaque psoriasis. These drugs may differ in time until Psoriasis Area and Severity Index (PASI) response is obtained. In this systematic review, we examined the time to onset of action for interleukin (IL)-17 and IL-23 agents in the treatment of psoriasis. The primary objective was the weighted mean time needed for 25% and 50% of patients with psoriasis to achieve PASI90. The medical databases PubMed, Web of Science and EMBASE were searched using the following terms: psoriasis AND (ixekizumab OR secukinumab OR brodalumab OR risankizumab OR guselkumab OR tildrakizumab). A total of 27 studies were included for data extraction and qualitative synthesis, and 26 of these were quantitatively analysed. The shortest time to 25% and 50% of patients to achieved PASI90 were seen with brodalumab 210 mg every 2 weeks (Q2W; 3.5 weeks and 6.2 weeks, respectively) followed by ixekizumab 80 mg Q2W (4.1 and 7.4 weeks, respectively) and ixekizumab 80 mg Q4W (4.6 and 8.1 weeks, respectively) dosages. In conclusion, clinical trials yielded shorter time to onset of action in studies assessing approved dosing ranges of IL-17 inhibitors compared with studies assessing IL-23 inhibitors.

Journal of the European Academy of Dermatology and Venereology: JEADV

Systematic Review on Rapidity of Onset of Action for Interleukin-17 and Interleukin-23 Inhibitors for Psoriasis

J Eur Acad Dermatol Venereol 2019 Aug 29;[EPub Ahead of Print], A Egeberg, YMF Andersen, AS Halling-Overgaard, F Alignahi, JP Thyssen, R Burge, L Mallbris 

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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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