Clinical and experimental dermatology · 2025
Dose modulation strategies in patients with psoriasis: real-world comparison between secukinumab and brodalumab for up to 1 year after dose spacing.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Mastorino Luca, Dapavo Paolo, Ortoncelli Michela, Bongiovanni Eleonora, Liao Yingying, Pelucchi Margherita, Leo Francesco, Quaglino Pietro, Ribero Simone
Аннотация
BACKGROUND: Modulating the regimen of biologics is of increasing interest in patients with psoriasis. This includes dose reduction (de-escalation) and dose augmentation (escalation). De-escalation strategies include reducing the single therapeutic dose, the mg kg-1 ratio or the number of injections, and dose spacing (D-S), extending the interval between administrations. Real-life data regarding dose de-escalation are lacking.
OBJECTIVES: To retrospectively analyse the effectiveness and drug survival of D-S of secukinumab and brodalumab in a real-world setting.
METHODS: This is a cohort study with retrospective analysis of the general characteristics of patients with psoriasis undergoing therapeutic biologic D-S with secukinumab or brodalumab and the effectiveness of D-S.
RESULTS: Eighty patients underwent dose modulation by D-S with the interval increased by 50% of the approved range. Overall, 31 (39%) were treated with secukinumab and 49 (61%) with brodalumab. After a mean of 35 months, the population underwent D-S. At D-S, the mean Psoriasis Area and Severity Index (PASI) was 0.1, ranging from 0.7 to 0.1 in the following year. PASI 100 (100% improvement) was achieved by 91% at the date of D-S and remained stable over the following year. Similar trends were seen for PASI 90 and absolute PASI ≤ 1, with 99% and 100% of patients, respectively, achieving these goals at the time of D-S. These levels were maintained at 12 months after D-S. The 12-month drug survival of the D-S regimen was 66%, with one-quarter of patients (20 of 80) returning to the standard dosage. PASI 100 was regained in two-thirds of these cases. Secukinumab showed a drug survival after D-S of 78%, compared with 59% for brodalumab. No differences in mean and relative PASI scores at any timepoint after D-S were found between the two treatments.
CONCLUSIONS: Therapeutic modulation of interleukin-17 inhibitors in patients with psoriasis and controlled disease seems an effective therapeutic strategy that maintains efficacy for up to 1 year in 40% of patients. No differences were observed between secukinumab and brodalumab during the D-S regimen.
OBJECTIVES: To retrospectively analyse the effectiveness and drug survival of D-S of secukinumab and brodalumab in a real-world setting.
METHODS: This is a cohort study with retrospective analysis of the general characteristics of patients with psoriasis undergoing therapeutic biologic D-S with secukinumab or brodalumab and the effectiveness of D-S.
RESULTS: Eighty patients underwent dose modulation by D-S with the interval increased by 50% of the approved range. Overall, 31 (39%) were treated with secukinumab and 49 (61%) with brodalumab. After a mean of 35 months, the population underwent D-S. At D-S, the mean Psoriasis Area and Severity Index (PASI) was 0.1, ranging from 0.7 to 0.1 in the following year. PASI 100 (100% improvement) was achieved by 91% at the date of D-S and remained stable over the following year. Similar trends were seen for PASI 90 and absolute PASI ≤ 1, with 99% and 100% of patients, respectively, achieving these goals at the time of D-S. These levels were maintained at 12 months after D-S. The 12-month drug survival of the D-S regimen was 66%, with one-quarter of patients (20 of 80) returning to the standard dosage. PASI 100 was regained in two-thirds of these cases. Secukinumab showed a drug survival after D-S of 78%, compared with 59% for brodalumab. No differences in mean and relative PASI scores at any timepoint after D-S were found between the two treatments.
CONCLUSIONS: Therapeutic modulation of interleukin-17 inhibitors in patients with psoriasis and controlled disease seems an effective therapeutic strategy that maintains efficacy for up to 1 year in 40% of patients. No differences were observed between secukinumab and brodalumab during the D-S regimen.