Efficacy and safety of ustekinumab in Japanese patients with moderate‐to‐severe plaque‐type psoriasis: Long‐term results from a phase 2/3 clinical trial

Abstract

This phase 2 ⁄ 3, double-blind, placebo-controlled study was designed to assess the safety and efficacy of ustekinumab in Japanese patients with moderate-to-severe plaque-type psoriasis. Overall, 158 patients were randomized to receive ustekinumab 45 or 90 mg at weeks 0, 4, and every 12 weeks, or placebo with cross-over to ustekinumab at week 12. The primary end-point was the proportion of patients achieving at least 75% improvement in Psoriasis Area and Severity Index (PASI 75) at week 12. Physician's Global Assessment (PGA), Dermatology Life Quality Index (DLQI), Nail Psoriasis Severity Index and joint pain Visual Analog Scale (VAS) were also measured. At week 12, 59.4% and 67.7% of ustekinumab 45 and 90 mg patients achieved PASI 75, respectively, compared with 6.5% in the placebo group (P < 0.0001 each). PASI 75 responses were maintained through week 64 in 65.0% and 78.6% of the ustekinumabtreated patients, respectively. Placebo cross-over patients had similar responses to ustekinumab-treated patients. Significant improvements in PGA, DLQI and VAS scores were observed at week 12 and generally maintained over time. Adverse events during the placebo-controlled period were similar among groups (45 mg, 65.6%; 90 mg, 59.7%; placebo, 65.6%). Serious adverse events were observed in 0%, 4.8% and 6.3% of patients, respectively. Through week 72, similar rates and types of adverse events and serious adverse events were reported in patients receiving 45 and 90 mg. Rates of injection site reactions and antibodies to ustekinumab were low. Ustekinumab was efficacious and generally well-tolerated in Japanese patients with moderate-to-severe plaque-type psoriasis through 72 weeks. These results are consistent with those reported in the global, phase 3 studies.

Impact of biologic therapies on risk of major adverse cardiovascular events in patients with psoriasis: systematic review and meta-analysis of randomized controlled trials

“…In all, 38 RCTs (identified in 38 reports)20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 met the eligibility criteria and were included, as shown in Figure 1. These trials involved a total of 18 024 patients with plaque psoriasis.…”

“…Patients in 27 RCTs20, 21, 22, 25, 27, 28, 29, 30, 31, 34, 35, 36, 37, 38, 39, 40, 43, 45, 46, 47, 48, 50, 52, 53, 57 did not experience MACEs while exposed to any interventions but 10 MACEs were observed during the randomized controlled phase of nine studies 23, 26, 32, 33, 42, 44, 49, 51. Overall, the pooled analysis of these nine trials found that there was no statistically significant difference in the risk of MACEs when comparing biologic therapies with placebo (pooled OR 1·45, 95% CI 0·34–6·24, P  = 0·62), as shown in Figure 2a.…”

Biologicals in the Treatment of Plaque Psoriasis: Drug Selection by Means of the SOJA Method

“…Ustekinumab 45 and/or 90 mg were more effective than placebo in studies with Asian patients [39,40]. In a Japanese study PASI-75 remained constant during in open label treatment of 1 year [39].…”

“…In a Japanese study PASI-75 remained constant during in open label treatment of 1 year [39]. Etanercept 50 mg (n=347) twice per week was less effective than ustekinumab (45 mg (n=209) or 90 mg (n=347) at weeks 0 and 4) in a direct open-label comparative study.…”

Squamous Cell Carcinoma of the Tongue in a Patient on Ustekinumab as the Treatment of Psoriasis

“…To understand the potential risks of malignancies from ustekinumab therapy, five randomized placebo-controlled trials of ustekinumab for the treatment of moderate-to-severe plaque psoriasis and three meta-analyses of randomized controlled trials and open-label extension studies were identified through literature review [10][11][12][13][14][15][16][17][18]. In general, malignancy excluding NMSC was not significantly increased in patients receiving long-term ustekinumab therapy when compared with The National Cancer Institute's Surveillance Epidemiology and End Results (NCI SEER) database [15,17].…”