Topical halcinonide may benefit patients with psoriasis with inadequate biologics response

Key takeaways:

• 60.9% of patients achieved PASI 75 with tildrakizumab alone.
• Improvement in PGA and body surface area involvement increased from 64% to 88% after adding halcinonide ointment.

Dermatologists should consider prescribing topical halcinonide 0.1% ointment as an adjunctive therapy for patients with moderate to severe plaque psoriasis that inadequately respond to biologics, according to a study.

“For patients lacking an adequate response to biologics alone, combinations of biologic therapy with other psoriasis treatments can be used for improvement,” Jerry Bagel, MD, MS, of the Psoriasis Treatment Center of Central New Jersey, and colleagues wrote.

In this prospective, open-label study, Bagel and colleagues evaluated the effectiveness and safety of tildrakizumab plus topical halcinonide 0.1% ointment in 25 adults (mean age, 52.6 years; 68% men) with moderate to severe plaque psoriasis, defined as body surface area (BSA) involvement of 10% or greater, through 24 weeks.

Each patient received 100 mg of tildrakizumab subcutaneously at weeks 0, 4 and 16.

Patients with a BSA greater than 3% at week 16 were instructed to apply halcinonide ointment twice daily through week 20, at which point they then continued without the ointment through week 24. Patients with a BSA less than or equal to 3% at week 16 were followed through week 24 without further treatment.

Results showed that 60.9% of patients achieved PASI 75 by week 16. By week 20, the proportion of patients that reached PASI 75 increased to 73.7%, and this was maintained at week 24.

Those patients who added halcinonide ointment as treatment experienced a 55% improvement in BSA, 29% improvement in PGA and 64% improvement in PGA x BSA at week 16 from baseline. After adding the ointment, these outcomes increased to a 78% improvement in BSA, 51% improvement in PGA and 88% improvement in PGA x BSA by week 20 and through week 24.

After using tildrakizumab monotherapy through week 16, the proportion of patients that reported a DLQI score of 0 or 1 increased from 4% to 39.2%. This further increased to 42.1% among all patients by week 20; however, researchers observed a decrease to 31.6% at week 24.

Those who used halcinonide ointment as an adjunctive therapy saw their mean DLQI of 50% at week 16 increase to 65% at week 20 and decrease to 61% at week 24. Those with a BSA less than or equal to 3% achieved a mean DLQI of 84% by week 16 and maintained that outcome through week 24.

Adverse events were reported in eight of the 25 patients, with two of the cases considered related to treatment. Most adverse events were mild and included rhinitis, cough and diarrhea.

According to the authors, this study shows that “adjunctive use of topical halcinonide 0.1% ointment enhanced patient response to tildrakizumab.” Moving forward, the authors recommend that patients who inadequately respond to tildrakizumab monotherapy should be considered for topical halcinonide as an adjunctive therapy.