Long‐term continuation with secukinumab in psoriasis: association with patient profile and initial psoriasis clearance

Abstract

Summary Background There are limited data regarding the long‐term continuation with biological therapy for patients with psoriasis. In particular, the reasons for secukinumab discontinuation have not been thoroughly investigated. Aim To better ascertain the real‐life continuation of secukinumab in psoriasis, we conducted a retrospective study to evaluate the incidence, causes and factors of secukinumab discontinuation in patients with psoriasis. Methods All patients treated with secukinumab for psoriasis in the Department of Dermatology (Toulouse University and Larrey Hospital, Toulouse, France), between September 2011 and June 2017, were enrolled in the study. Results Of the 91 patients in the study, 22 (24.2%) discontinued secukinumab. In 14 (15%) patients, the discontinuation was due to loss of efficacy. Two patients stopped treatment because they planned a pregnancy and five patients stopped because of adverse events. A longer disease duration (P = 0.01) and presence of palmoplantar psoriasis (P = 0.01) seem to be predictive factors for treatment failure. Patients reaching 90 or 100% improvement in Psoriasis Area and Severity Index (PASI90 and PASI100, respectively) at weeks 12–16 had a lower risk of long‐term treatment discontinuation compared with patients who had less complete clearance (P = 0.04). Conclusion Long‐term persistence of secukinumab appears to be good, as only 24.2% (n = 22) of the patients in this study discontinued secukinumab over the follow‐up period. Loss of efficacy prompted discontinuation in about 14% of patients by the 2‐year follow‐up. Persistence appears to be lower in patients with palmoplantar psoriasis and in patients previously exposed to many systemic treatments. Optimal therapeutic response at 12–16 weeks as defined by reaching PASI90–100 seems to be predictive of long‐term treatment persistence.

Real‐world data from a single Greek centre on the use of secukinumab in plaque psoriasis: effectiveness, safety, drug survival, and identification of patients that sustain optimal response

“…9,14,17 This discrepancy may be explained not only by selection bias and different management practices across centres but also by diverse patient profiles among real-life cohorts. 7 Our sample, including a high and/or variable proportion of patients with overweight/obesity (78.2%), tobacco use (55.8%), concurrent PsA (38.2%), ≥1 metabolic, cardiovascular, or psychiatric comorbidity (78.3%) and prior treatment failure (71%/29% had failed ≥2 systemic/≥2 biologic agents, respectively), may represent a difficult-to-treat population. The significant proportion of subjects with a relatively low baseline PASI (PASI <10) in this cohort (28/85; 32.9%) may mirror the absence of washout periods when switching among biologics in everyday practice.…”

“…Only a few real-life studies have so far investigated the performance of secukinumab over a follow-up period of more than 52 weeks. [7][8][9][10][11] With several therapeutic agents available, the need for individualized disease management is now more compelling than ever. To guide a personalized treatment approach, identification of possible predictive factors of clinical response is fundamental.…”

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

“…Although secukinumab has been shown to be well tolerated and effective in treating patients with plaque psoriasis and PsA in multiple clinical trials (7-9,29-34) with up to 5-year follow up (35), randomized controlled trials are likely to enroll patient populations with more stringent inclusion/exclusion criteria and generally the study design allows a short-term observation compared to the real-world setting. A variety of real-world studies have been recently published: some of them analyzed secukinumab drug survival (36)(37)(38)(39), whereas others assessed its efficacy in psoriasis patient populations with peculiar features, or assessing its effectiveness as improvement of DLQI, BSA, PGA, and PASI scores (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Nevertheless, they reported favorable secukinumab safety and effectiveness in terms of mean reduction of PASI value over time, as patient rates achieving PASI 75, PASI 90, and PASI 100 responses at different timepoints, Investigator's Global Assessments or improvements in quality of life measures (11)(12)(13)(14)(15)(16)(17)(18)(19)22).…”

“…Recently, some real-world studies describing the effectiveness and safety of secukinumab have been published, but only one study included data on the absolute residual PASI score (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Indeed, the effectiveness of antipsoriatic treatments is usually reported as the relative 75%, 90%, or 100% improvement from baseline on the Psoriasis Area Severity Index (PASI 75, PASI 90, PASI 100), though there is emerging interest in the evaluation of absolute PASI score reduction as a better benchmark of therapeutic response and the higher clinical relevance of the remaining absolute PASI score as therapeutic target (i.e.…”

Real world data from the use of secukinumab in the treatment of moderate‐to‐severe psoriasis, including scalp and palmoplantar psoriasis: A 104‐week clinical study

“…A significant amount of efficacy and safety data is extracted from RCTs, whereas limited data is available in a real-world setting (Ferrières et al, 2019;Galluzzo et al, 2018;Georgakopoulos, Ighani, Zhou, & Yeung, 2018;Magnano et al, 2018;Schwensen et al, 2017;Sotiriou, Tsentemeidou, Vakirlis, Sideris, & Ioannides, 2019) where patients' clinical characteristics may differ from those enrolled in clinical programs. The aim of this study was to analyze the efficacy of secukinumab at Weeks 4,16, 52, and 104 of treatment in patients with moderate-to-severe chronic plaque psoriasis, including difficult-to-treat sites (scalp and palmoplantar), at the psoriasis clinic of the Second Dermatology Department of the National and Kapodistrian University of Athens, "Attikon" University Hospital.…”