Key Point: It is unclear whether administering biologics to patients with psoriasis within 2 years of diagnosis has a significant impact on clinical outcomes.
In patients with moderate to severe psoriasis (PsO), early treatment is not critical to optimizing outcomes, although ixekizumab was associated with numerically higher response rates than other individual biologics regardless of disease duration, according to study findings published in the Journal of Dermatological Treatment.
Investigators sought to determine if early intervention with biologics yields better treatment outcomes in patients with moderate to severe PsO and if superior outcomes are associated with specific drug classes or individual biologics. The primary endpoint was the proportion of patients achieving 100% improvement in Psoriasis Area Severity Index score (PASI 100) at week 12.
In their post-hoc analysis, the investigators used real-world data from patients enrolled in the 1981 Psoriasis Study of Health Outcomes (PSoHO), an ongoing 3-year observational cohort study. In the current analysis, patients were stratified into 2 subgroups based on disease duration: greater than 2 years (93% of patients) vs 2 years or less (7% of patients). Baseline characteristics were otherwise similar across the 2 subgroups, except for prevalence of nail PsO, psoriatic arthritis, and prior exposure to biologics.
Analysis included evaluation of patients receiving the anti-interleukin (IL)-17A (ixekizumab and secukinumab) vs the “other biologics”, those receiving anti-IL-17A vs other drug classes, and pairwise comparisons of those receiving ixekizumab vs individual biologics. Drugs in the other biologics cohort included brodalumab, guselkumab, risankizumab, tildrakizumab, ustekinumab, adalimumab, infliximab, etanercept, and certolizumab. Patients with missing outcomes were imputed to be nonresponders.
“Taken together, our results do not clearly indicate that treating patients early (i.e. within the first 2 years of establishing the diagnosis) is critical in achieving optimal patient outcomes.”
Regarding the impact of PsO duration, at week 12 there were negligible differences between the anti-IL-17A cohort and the cohort treated with other biologics in the numeric response rate for PASI 100. Independent of disease duration, the PASI-100 response rate was higher in those receiving anti-IL-17A than in patients treated with other biologics. Among patients with a PsO duration of 2 years or less, 36.7% vs 21.8%, respectively, achieved PASI 100. Among those with a PsO duration greater than 2 years, PASI 100 was achieved in 35.8% vs 21.9% of patients, respectively. The adjusted odds ratio (aOR) for disease duration greater than 2 years showed a significant difference between the 2 cohorts (aOR, 2.1; 95% CI, 1.7-2.5). For patients with PsO duration of 2 years or less, there was no significant difference in treatment response.
Study limitations include an underpowered sample size in the cohort with PsO of 2 years or less, with just 19 of 138 patients having received prior treatment with a biologic. Additionally, examination of treatment outcomes only at week 12 fails to provide robust evidence regarding whether early disease interventions lead to increased patient benefits.
The researchers concluded, “Taken together, our results do not clearly indicate that treating patients early (ie within the first 2 years of establishing the diagnosis) is critical in achieving optimal patient outcomes.” They added, “Furthermore, patients treated with ixekizumab [showed] numerically higher response rates relative to other individual biologics irrespective of disease duration. Long-term follow-up data are necessary to understand if treating patients with biologics early has any significant benefit.”
Disclosure: This research was supported by Eli Lilly and Company. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
References:
Pinter A, Eyerich K, Costanzo A, et al. Association of disease duration and PASI response rates at week 12 in patients with moderate-to-severe plaque psoriasis receiving biologics in the real-world psoriasis study of health outcomes (PSoHO). J Dermatolog Treat. Published online May 26, 2024. doi:10.1080/09546634.2024.2350227
