Secukinumab improves the signs and symptoms of moderateto-severe plaque psoriasis in subjects with involvement of hands and/or feet: subanalysis of a randomized, double-blind, placebo-controlled, phase 2 dose-ranging study Editor Psoriasis affecting the hands and/or feet has greater impact on quality of life than other forms of the disease and is more difficult-to-treat, as topical and systemic therapies and phototherapy are often ineffective, difficult to administer, and/or limited by toxicity effects. 1,2 Biologics targeting pro-inflammatory cytokines such as tumour necrosis factor (TNF) and interleukin (IL)-12/23 have shown efficacy in managing moderate-to-severe plaque psoriasis 3,4 and have also demonstrated efficacy in the treatment of difficult-to-treat disease, including hand/foot psoriasis. 5-7 Secukinumab (Novartis Pharma AG, Basel, Switzerland) is a fully human IgG1j anti-IL-17A monoclonal antibody that selectively suppresses the inflammatory cascade induced by IL-17A. The efficacy and safety of secukinumab for the treatment of moderate-to-severe psoriasis has been demonstrated in proofof-concept and other phase 2 studies. [8][9][10] In a post hoc analysis of a multicentre, randomized, double-blind, placebo-controlled, dose-ranging phase 2 study, 9 we evaluated the effects of secukinumab in a subgroup of subjects with moderate-to-severe psoriasis involving the hands and/or feet.A complete description of the design/methods for the primary study was published previously. 9 Subjects (N = 125) were randomized 1 : 1 : 1 : 1 : 1 to four subcutaneous secukinumab regimens (1 9 25 mg, 3 9 25 mg, 3 9 75 mg, 3 9 150 mg) or matching placebo at baseline and Weeks 4 and 8. After the 12-week treatment period, subjects entered a 24-week follow-up period. Subjects ≥18 years with a ≥6-month history of moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥12, overall body [6-point static] investigator's global assessment (IGA) score ≥3, and body surface area involvement ≥10%) were enrolled. Our analysis was conducted on a subgroup with a baseline hand/foot 5-point static IGA score ≥2 (Table 1). The palm or sole most seriously affected at baseline was assessed throughout the study. Whole-body outcomes were assessed using PASI scores. 11 Secukinumab's efficacy was assessed as the percentage of subjects achieving an IGA response at Week 12 (those achieving a score of 0 [clear] or 1 [almost clear/minimal] and a ≥2-point improvement on the 5-point hand/foot IGA scale compared with baseline). Percentages of subjects achieving PASI 75 (≥75% reduction in PASI score from baseline) and PASI 90 (≥90% reduction from baseline) responses were also evaluated at Week 12. Comparisons between secukinumab and placebo were performed using the Cochran-Mantel-Haenszel (CMH) test,
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