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Negative HLA-C*06:02 status should not deter ustekinumab use in psoriasis
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Researchers found no need to exclude patients with psoriasis from ustekinumab treatment because of a negative HLA-C*06:02 genotype status.
The meta-analysis included eight studies and 937 patients in the analysis of Psoriasis Area and Severity Index (PASI75) response after 6 months of ustekinumab (Stelara, Janssen) treatment.
The PASI75 response rates were higher among HLA-C*06:02-positive patients in all included studies, with a pooled risk difference (RD) of 0.24 (95% CI, 0.14 to 0.35) in favor of HLA-C*06:02-positive patients. This means that if 100 HLA-C*06:02-positive and 100 HLA-C*06:02-negative patients were treated with ustekinumab, 24 more patients in the positive group would achieve PASI75.
In the HLA-C*06:02-positive group, response rates varied from 62% to 98%, with a median rate of 92%. In the HLA-C*06:02-negative group, response rates varied from 40% to 84%, with a median of 67%.
Researchers found that PASI75 response rates after 6 months were high in both HLA-C*06:02-positive and HLA-C*06:02-negative patients.
At 3 months, response rates were higher in HLA-C*06:02-positive patients in all but one study.
Researchers said that although the response rates between the groups were statistically significant, the clinical significance is debatable.
“Clinical relevance of the [risk differences] found is questionable because underlying response rates were high in both groups,” Lieke J. van Vugt, MD, of the department of dermatology, Radboud University Medical Centre, Radboud Institute of Health Sciences, Nijmegen, the Netherlands, and colleagues wrote.
“... Heterogeneity complicated generalizability and thus implementation of our findings, which may prohibit the current use of HLA-C*06:02 as a single predictor for ustekinumab treatment response in patients with psoriasis in clinical practice,” they wrote. “Realization of personalized treatment in psoriasis care may be dependent on finding a set of biomarkers, rather than a singlemarker, that in combination are strongly predictive of therapeutic response.” – by Abigail Sutton
Disclosures: Van Vugt reported carrying out clinical trials for AbbVie, Celgene, Janssen and Novartis. Please see the study for all other authors’ relevant financial disclosures.