PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines

Belinchón, Isabel; Daudén, E.; Foraster, Carlos Ferrándiz; González‐Cantero, Álvaro; Carrascosa, José Manuel

doi:10.1080/09546634.2021.1890683

Cited by 20 publications

(20 citation statements)

References 121 publications

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“…Interestingly, inspection of Table 1 suggests a temporal trend for the use of more stringent PASI criteria (from 75 to 90% improvement [PASI 75 and PASI 90, respectively]), thus reflecting the advent and efficacy of biologicals ( 64 , 65 ). More recently, studies have used complete resolution of lesions (PASI 100) as an endpoint that has been met more frequently with biologicals than with conventional therapies in moderate to severe psoriasis ( 66 ). These findings suggest that PASI 100 could be a feasible target for early intervention for psoriasis.…”

Section: Assessing the Benefit Of Early Interventionmentioning

confidence: 99%

Early intervention in psoriasis: Where do we go from here?

Felix

Sampaio

Silva³

et al. 2022

Front. Med.

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Patients with psoriasis often have comorbidities and are at increased risk of developing several complications compared with the general population. Knowledge on the role of immune mediators and systemic inflammation in psoriasis has led to the hypothesis that early intervention with systemic therapy has the potential to modify the course of the disease and reduce the risk of long-term adverse outcomes. In this article, we address some potential issues that need to be considered before early intervention can be implemented routinely. The first is determining what constitutes “early” intervention for psoriasis. A second point is whether the intervention should be considered for patients with early disease or for selected subsets based on risk stratification. A third important consideration is defining success for early intervention. Finally, adoption of early and effective intervention should be based on high-level evidence. Ideally, randomized trials would be the best strategy to compare early vs. late systemic treatment in patients with psoriasis, probably using the frequency of long-term outcomes as primary endpoint, with cutaneous and pharmacoeconomic outcomes assessed secondarily.

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Section: Assessing the Benefit Of Early Interventionmentioning

confidence: 99%

Early intervention in psoriasis: Where do we go from here?

Felix

Sampaio

Silva³

et al. 2022

Front. Med.

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“…Moreover, since the arrival of the newer class biologics (i.e. interleukin (IL)‐17 and IL‐23 inhibitors), long‐term, (near) complete skin clearance (CSC) has become reality 3,4 …”

Section: Introductionmentioning

confidence: 99%

“…In clinical trials, the novel class biologics showed superior efficacy compared to the older classes, that is, tumour necrosis alpha (TNFα) inhibitors (TNFi) and the IL‐12/23p40 inhibitor ustekinumab (UST), in both short and long term 1,3,4,9–14 . However, data from daily practice and/or registries might better reflect the real‐world effectiveness of biologics.…”

Section: Introductionmentioning

confidence: 99%

“…inhibitor ustekinumab (UST), in both short and long term. 1,3,4,[9][10][11][12][13][14] However, data from daily practice and/or registries might better reflect the real-world effectiveness of biologics. In particular, drug survival is a representative measure for therapy effectiveness in the real-world setting.…”

mentioning

confidence: 99%

“…interleukin (IL)-17 and IL-23 inhibitors), long-term, (near) complete skin clearance (CSC) has become reality. 3,4 Among the IL-17 inhibitors (IL-17i), secukinumab (SEC) and ixekizumab (IXE) inhibit the effector cytokine IL-17A, whilst brodalumab (BRO) targets its receptor (IL-17R A ). 5 The European Medicines Agency (EMA) authorized SEC, IXE and BRO for moderate-to-severe Pso in 2015, 2016 and 2017, respectively.…”

mentioning

confidence: 99%

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Blocking interleukin‐17 in psoriasis: Real‐world experience from the PsoPlus cohort

Schots

Soenen

Blanquart

et al. 2023

Acad Dermatol Venereol

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Background Real‐world studies on the use of biologics in psoriasis (Pso) are increasing, but still scarce. Trough concentrations (Cts) of interleukin‐17 inhibitors (IL‐17i) seem promising for clinical decision‐making, but their value in daily practice has yet to be proven. Objectives To report on IL‐17i effectiveness, treatment modifications and Ct use in our clinic. Methods Data were collected from IL‐17i‐treated Pso patients followed up in the PsoPlus clinic at the Dermatology department, Ghent University Hospital, Belgium. Descriptive statistics and Kaplan–Meier analysis were performed. Results A total of 111 patients were included, counting for 134 IL‐17i courses (secukinumab, ixekizumab, and brodalumab). Fifty‐five per cent of the patients were bio‐naive prior to IL‐17i initiation. During maintenance, merely 97.0% and 77% achieved near‐complete and complete skin clearance, respectively. Major reasons for treatment modification were suboptimal response (63.0%) and safety issues (9.3%). Reported modifications were switch (25.4%), dose escalation (11.9%), dose de‐escalation (6.7%), treatment association (6.0%) and IL‐17i stop (3.0%). Overall drug survival was 69.0 months, without difference between the different IL‐17i (p = 0.078). Ixekizumab tended to have the highest survival. Drug survival was higher in bio‐naive subjects compared to bio‐experienced subjects (p = 0.011). Ct was measured in 20 patients and interpreted post hoc. In 85%, the clinical decision was in accordance with the Ct (e.g. substantiated need for dose escalation). For the other cases, the Ct would have led to another clinical decision if known at that time. Conclusions This real‐world study showed that IL‐17i are very effective drugs for Pso, with ixekizumab as leading biologic. Prior bio‐experience seemed to impact IL‐17i drug survival. Treatment modifications were mainly performed in case of insufficient response, primarily via switch and dose escalation, and least frequently in ixekizumab patients. Ct might rationalize clinical decision‐making; however, there is need for standardized algorithms to corroborate its use.

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Ixekizumab trough concentrations in psoriasis: Paving the way towards personalised therapy: A cohort study

Schots,

Soenen,

Thomas

et al. 2024

JEADV Clinical Practice

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BackgroundBiologics for psoriasis demonstrate varying clinical outcome in real‐world practice, implying potential under‐ and overexposure.ObjectivesIn this prospective cohort study we aimed to develop and validate an in‐house sandwich‐type enzyme‐linked immunosorbent assay (ELISA) for ixekizumab (IXE), and to explore whether there is an exposure‐response relationship in standard maintenance dose for IXE, and whether patient factors influence IXE exposure and clinical outcome.MethodsThis was a prospective, multicentric, cohort study in psoriasis patients treated with IXE according to standard dosing regimen (BIOLOPTIM‐IXE). IXE trough concentrations (TCs) in sera collected at multiple timepoints were measured using an in‐house immunoassay.ResultsUsing MA‐IXE117E12 and MA‐IXE100F5‐biotin as the capture and detection antibodies, respectively, an ELISA was developed with an exposure‐response curve ranging from 10 to 0.16525 ng/mL. One hundred‐fifteen steady‐state serum samples from 48 patients (17 [35.4%] bio‐experienced; median body weight, 81.5 kg) were measured. Optimal responders (Psoriasis Area and Severity Index [PASI] ≤ 2) had significantly higher TCs than suboptimal responders (PASI > 2) (median TCs, 4.4 and 3.0 μg/mL, respectively; p = 0.026). Median cohort IXE TC was 4.1 µg/mL [2.8−6.1]. An optimal steady‐state IXE TC of 3.4 µg/mL was identified for clinical outcome defined by absolute PASI. Median TCs and absolute PASI were significantly lower and worse, respectively, in patients ≥ 90 kg (p < 0.001 and p = 0.013, respectively) and in bio‐experienced subjects (p < 0.001 and p = 0.029, respectively).ConclusionsThis study identified an IXE exposure‐response relationship and an optimal effective steady‐state TC of 3.4 µg/mL in real‐world psoriasis patients, revealing the potential of therapeutic drug monitoring in optimising IXE use.

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PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines

Cited by 20 publications

References 121 publications

Early intervention in psoriasis: Where do we go from here?

Early intervention in psoriasis: Where do we go from here?

Blocking interleukin‐17 in psoriasis: Real‐world experience from the PsoPlus cohort

Ixekizumab trough concentrations in psoriasis: Paving the way towards personalised therapy: A cohort study

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