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Secukinumab for Plaque Psoriasis

Summary and Comment |
July 9, 2014

Secukinumab for Plaque Psoriasis

  1. Mark V. Dahl, MD

PASI, global assessment, and quality-of-life measures all showed efficacy.

  1. Mark V. Dahl, MD

Secukinumab is a recombinant, high-affinity, fully humanized IgG monoclonal antibody that selectively binds and neutralizes interleukin-17A (IL-17A). IL-17A is a “master cytokine” that mediates the pathogenesis of psoriasis, so neutralizing it clears psoriasis. Two new double-blind, placebo-controlled, parallel-group, phase 3 trials examined secukinumab treatment of plaque psoriasis.

ERASURE compared two injected doses of secukinumab (150 mg or 300 mg) with placebo in 738 patients; FIXTURE compared the secukinumab doses with standard doses of etanercept (50 mg twice weekly) and with placebo in 1306 patients. Investigators measured disease activity using global assessment (static 5-point scale) and the psoriasis area-and-severity index (PASI) score. Injections were performed at baseline; weeks 1, 2, 3, and 4; and then every 4 weeks. Etanercept was given twice weekly from baseline until week 12 and then once weekly.

Secukinumab was more efficacious than all comparators for all endpoints. A greater percentage of secukinumab recipients than placebo recipients achieved at least 75% improvement on PASI and clear or almost clear global assessment scores (P<0.001). The 300-mg dose of secukinumab was associated with better response than the 150-mg dose. Quality-of-life measures were significantly improved, too. In FIXTURE, secukinumab was superior to etanercept in efficacy and in speed of response (4 weeks to 50% reduction in PASI score from baseline). Response to secukinumab continued until about week 16, after which mean PASI scores remained stable. Some secukinumab patients developed candida infections that resolved or responded quickly to treatment. Nine subjects (1%) developed grade 3 neutropenia. Nasopharyngitis, headache, and upper respiratory infections were more common among secukinumab recipients.

Comment

Each of these separate studies reported together confirms the result of the other. Results were predictable from results of previous phase 2 clinical trials. Secukinumab appears to be very effective for generalized plaque psoriasis. The study was not designed to statistically differentiate between the 150-mg and 300-mg dose regimens, but the 300-mg dose seems to have been more effective.

  • Disclosures for Mark V. Dahl, MD at time of publication Consultant / Advisory board Makucell, Inc.; Castle Diagnostics, Inc.; Up To Date; Ulthera, Inc.; Biohealth, Inc. Equity Elorac, Inc.; Makucell, Inc. Editorial boards UpToDate

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Reader Comments (1)

PETER MOTEL Physician, Dermatology

informative

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