Brodalumab bests other biologics in onset of action in psoriasis

Interleukin-17 inhibition with brodalumab was associated with a rapid onset of action compared with other biologics in patients with moderate to severe psoriasis, according to a study.

“The impact of psoriasis on quality of life arises from both physical symptoms, such as pain and pruritus, and the psychosocial effects of the often highly visible lesions,” Richard G. Fried, MD, PhD, of Yardley Dermatology Associates, in Yardley, Pennsylvania, and colleagues wrote.

The researchers suggested that time to onset of symptoms should be a critical factor in therapeutic selection in patients with moderate to severe psoriasis; however, they noted that there is “fluidity” in what qualifies as a rapid response or time to response expectations among patients.

In this context, they assessed brodalumab (Siliq, Ortho Dermatologics), an anti-interleukin-17 receptor A monoclonal antibody, for time-to-effectiveness parameters.

Previous results from the AMAGINE trial series suggested that the importance of a rapid onset of action may vary depending on a number of factors, including age, severity of disease and experience with other biologics.

For example, patients aged 18 to 30 years expected a response of a 50% improvement from a hypothetical biologic therapy in 14.8 days, while those aged 51 years and older expected to respond by 19.4 days. Patients with moderate disease expected a response by 15.5 days, while the duration was 18.5 days for those with severe disease.

The current study included data for patients treated with brodalumab 210 mg administered twice weekly. Onset of action data were compared directly or indirectly with similar data in patients treated with other drugs, such as ixekizumab (Taltz, Lilly), secukinumab (Cosentyx, Janssen), risankizumab (Skyrizi, AbbVie) and guselkumab (Tremfya, Janssen).

Results showed that the mean time for 50% of patients to achieve PASI 90 was fastest among patients treated with brodalumab, at 6.2 weeks. By comparison, the next shortest duration to this outcome was observed among patients treated with 80 mg ixekizumab twice weekly, at 7.4 weeks. Other biologics, such as secukinumab, required as long as 16 weeks to reach this endpoint.

Similarly, brodalumab bested ustekinumab in terms of relief of pruritis after 2 weeks of treatment (36.4% vs. 17.1%; P < .01).

“Direct and indirect comparisons with other interleukin-targeting drugs support brodalumab’s more rapid onset of treatment effects, including skin clearance and relief of itch and pain,” the researchers concluded.