Brodalumab to the Rescue: Efficacy and Safety of Brodalumab in Patients with Psoriasis and Prior Exposure or Inadequate Response to Biologics

Abstract

While biologic therapies for psoriasis are effective for many patients, some patients may lose response, have inadequate control of disease, or develop intolerance to certain biologic agents. It may therefore be beneficial for patients whose psoriasis fails to respond to one biologic to switch to a different biologic therapy, in particular one with a different mechanism of action. However, it remains unclear how prior biologic exposure or lack of response affects the efficacy and safety of subsequent biologics in patients with moderate-to-severe psoriasis.

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis

“…Brodalumab is a fully human IL-17 receptor A antagonist approved for the treatment of moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy and have failed to respond or have lost response to other systemic therapies [ 20 ]. The clinical benefit and safety profile of brodalumab are well established in patients with moderate-to-severe psoriasis [ 19 , 24 ]. In a recent systematic literature review and metaanalysis of more than 40 RCTs of psoriasis treatments, brodalumab demonstrated greater psoriasis area and severity index (PASI) response rates and had a higher likelihood of sustained PASI response rates for both short-term (16 weeks) and long-term (60 weeks) treatment of moderate-to-severe psoriasis than other biologics [ 13 , 24 ].…”

“…Although difficult-to-treat psoriasis often refers to lesions in particular areas of the body, biologic failure is another challenge in psoriasis treatment [ 19 ]. Biologic failure caused by drug ineffectiveness occurs when patients do not initially respond, lose response over time, or are intolerant to treatment; in such situations, therapy switch or adjuvant treatment is often required, which in practice is usually with a biologic that has a different mechanism of action [ 19 , 53 ].…”

“…Although difficult-to-treat psoriasis often refers to lesions in particular areas of the body, biologic failure is another challenge in psoriasis treatment [ 19 ]. Biologic failure caused by drug ineffectiveness occurs when patients do not initially respond, lose response over time, or are intolerant to treatment; in such situations, therapy switch or adjuvant treatment is often required, which in practice is usually with a biologic that has a different mechanism of action [ 19 , 53 ]. The most common reason for biologic discontinuation is loss of efficacy [ 19 ], which is also a concern for patients with psoriasis in difficult-to-treat areas [ 3 , 4 ].…”

“…Although difficult-to-treat psoriasis often refers to lesions in particular areas of the body, an added challenge in treating nonstandard psoriasis includes whether the patient had inadequate response to prior biologic treatment [ 19 ]. Psoriatic lesions generally respond to biologic treatment, but some patients present with lesions that fail to respond to biologics.…”

“…Psoriatic lesions generally respond to biologic treatment, but some patients present with lesions that fail to respond to biologics. An initial nonresponsiveness to treatment is called primary biologic failure, whereas an initial favorable response to treatment followed by loss of response over time is called secondary biologic failure [ 19 ]. The most common reason for biologic discontinuation is loss of efficacy [ 19 ], which is also a concern for patients with psoriasis in difficult-to-treat areas [ 3 , 4 ].…”