Onset of Action of Biologics in Patients With Moderate-to-Severe Psoriasis

Background: The advent of biologics has improved patient outcomes in the treatment of moderate-to-severe psoriasis. The time it takes for patients to see clinically meaningful improvement is an important aspect of disease management. OBJECTiIVE: To review the clinical data on the use of biologics in moderate-to-severe psoriasis, identifying which biologics may offer the quickest results.

Methods: A review of the published and presented efficacy data on adalimumab, infliximab, ustekinumab, etanercept, brodalumab, ixekizumab, and secukinumab to estimate the time to achieve clinically meaningful outcome; defined as time for 25% of patients to achieve Psoriasis Area and Severity Index (PASI) 75, or a 50% reduction in mean baseline PASI.

Results: Clinically meaningful outcomes were achieved within 2-11 weeks with biologics. Calculated times for 25% of patients to achieve PASI 75 were 2.1 [95% CI 2.0-2.3] weeks (brodalumab), 2.4 weeks (ixekizumab), 3.0 weeks (high-dose secukinumab), 3.5 weeks (infliximab), 4.6 weeks (adalimumab and high-dose ustekinumab), 5.1 weeks (low-dose ustekinumab), 6.6 weeks (high-dose entanercept), and 9.5 weeks (low-dose entanercept). Calculated times for 50% reduction in baseline PASI were 1.8 [95% CI 1.7-1.9] weeks (brodalumab), 1.9 weeks (ixekizumab), 3.0 [95% CI 2.8-3.2] weeks (high-dose secukinumab), 3.5 weeks (adalimumab), 3.7 weeks (infliximab), 5.1 weeks (low-dose ustekinumab), 6.5 weeks (high-dose entanercept), and 10.9 weeks (low-dose entanercept).

Conclusions: Brodalumab may have the most rapid onset of action of any biologic therapy used in psoriasis. Similar results were seen with both outcome measures and will have important implications in psoriasis management. <p><em>J Drugs Dermatol. 2018;17(3):247-250.</em></p>.