Biologicals for moderate-to-severe plaque type psoriasis in pediatric patients

Abstract

Introduction: Psoriasis affects around 2% of children in Europe. The majority of cases is readily managed with topical treatments using corticosteroids without or with calcipotriol. More resistant and extensive moderate-to-severe cases require UVA or UVB phototherapies or conventional systemic treatment including ciclosporin, acitretin and methotrexate. However, these therapies are associated with a low tolerability and potential cumulative long-term adverse effects and toxicities. Areas covered: About 15 years ago, the first biological appeared for the treatment of moderate-tosevere plaque type psoriasis in adult patients. Several years later, the first biologic treatment to be approved in children was etanercept, a soluble receptor that binds both tumor necrosis factor (TNF)-α and β followed by adalimumab, a monoclonal antibody against TNF-α, and currently by ustekinumab, a monoclonal IL12/23 p40 antagonist and, very recently, secukinumab and ixekizumab, both IL17 antagonists. All these biologic treatments brought significantly improved treatment results compared to light-based therapies and conventional treatments and present very good tolerance and safety profiles. Expert opinion: Due to their excellent efficacy and safety profiles ustekinumab, secukinumab and ixekizumab could currently be considered as a first-line treatment options for moderate-to-severe childhood and adolescent psoriasis requiring a systemic treatment.

Long-term Efficacy and Safety of Up to 108 Weeks of Ixekizumab in Pediatric Patients With Moderate to Severe Plaque Psoriasis

“…However, 5 biologics (etanercept, adalimumab, ustekinumab, secukinumab, and ixekizumab) for pediatric psoriasis have recently been approved by the European Medicines Agency, 4 of which (etanercept, ustekinumab, secukinumab, and ixekizumab) have also been approved by the US Food and Drug Administration . These biologics are highly efficacious with excellent tolerance and safety profiles …”

“…ediatric plaque psoriasis affects approximately 1% of children and adolescents, 1,2 with a median age at onset of 7 to 10 years. 3 This condition impairs the quality of life 4 of pediatric patients 4 and their parents, 5 interfering with self-esteem, family and social relationships, school, and worklife balance. 6,7 Psoriasis in certain locations, such as the face, scalp, palms and soles, nails, and genital region, has a disproportionately greater effect on a patient's quality of life because of its high visibility or challenge in treating given the involvement of more sensitive areas that may be more recalcitrant to topical agents.…”

“…10,11 These biologics are highly efficacious with excellent tolerance and safety profiles. 4 Ixekizumab, which is approved as a first-line option for treatment of moderate to severe psoriasis in children aged 6 years to younger than 18 years, 1,4 was found to be superior to placebo after 12 weeks of treatment, and these responses were sustained through week 48 in the IXORA-PEDS (Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate Safety, Tolerability, and Efficacy of Ixekizumab in Patients From 6 to Less Than 18 Years of Age With Moderateto-Severe Plaque Psoriasis) trial, a phase 3 randomized clinical trial. 1 In this trial, we evaluated the long-term efficacy and safety of ixekizumab for pediatric patients with moderate to severe psoriasis up to 108 weeks.…”

Physician-reported Clinical Unmet Needs, Burden and Treatment Patterns of Paediatric Psoriasis Patients: A US and EU Real-world Evidence Study

“…Etanercept was the first biologic agent approved, and is the most extensively studied agent in paediatric PsO (12). There are currently 5 biologic agents approved for moderate to severe paediatric PsO: etanercept, adalimumab (EU only), ustekinumab, secukinumab and ixekizumab (12)(13)(14)(15). Notably, both secukinumab and ixekizumab have only recently been approved for this indication.…”