Ixekizumab efficacy in psoriasis may have implications in European reimbursement criteria

Ixekizumab was associated with greater efficacy than etanercept in a cohort of European patients with moderate to severe psoriasis, regardless of reimbursement criteria in the country where the patient was treated, according to a study.

According to Elizabeth Riedl, MD, of Eli Lilly, and colleagues, most guideline documents recommend biologics for moderate to severe psoriasis.

“While eligibility criteria are primarily defined by clinical treatment guidelines, access to these therapies varies between European countries and is regulated by country-specific reimbursement criteria,” the researchers wrote.

The data set is a post-hoc combined subgroup analysis of the UNCOVER-2 and UNCOVER-3 trials reporting on the efficacy of ixekizumab compared with etanercept in this patient population. The analysis included 736 patients treated with ixekizumab and 740 patients treated with etanercept.

Eligible participants had been stratified by groups based on reimbursement criteria from eight European countries. Specifically, the researchers classified patients based on whether they met or failed to meet biologic eligibility criteria for their specific country.

Baseline and 12-week data for the two drugs underwent analysis. The researchers assessed efficacy based on PASI and DLQI scores.

Results showed that ixekizumab was associated with PASI 75 rates ranging from 83.3% to 89.7%, while PASI 90 rates ranged from 69.8% to 76.3% and PASI 100 rates ranged from 33.3% to 50%. Conversely, etanercept yielded PASI 90 rates that ranged from 16.7% to 25.1%, while PASI 100 rates were from 0% to 7.2%.

Overall, the composite outcomes as assessed by PASI scores were significantly better for ixekizumab compared with etanercept (P < .05). Importantly, this outcome was observed “irrespective” of whether prespecified reimbursement criteria were met for the countries. The only exception to this was for PASI 100 response in Belgium. In this case, the sample size was too small, according to the researchers.

Regarding DLQI 0/1 response rates, ixekizumab also yielded stronger outcomes than etanercept (OR range = 2.44-5.29).

The study is limited by the post-hoc nature of the analysis.

“The overall high efficacy of ixekizumab, and the consistency of the higher treatment effect compared with etanercept, in patients with moderate to severe psoriasis across a range of European biologic treatment reimbursement eligibility criteria provides new insights to inform treatment decisions in clinical practice,” the researchers concluded.