Brodalumab May Enhance Skin Clearance, QOL vs Ustekinumab for Psoriasis

Brodalumab may better improve skin manifestations and quality of life (QOL) compared with ustekinumab in patients with moderate to severe psoriasis, regardless of the presence of aggravating and potentially treatment-confounding lifestyle risk factors.

Published recently in Dermatology and Therapy, authors of the study note that although genetic factors may predispose patients with psoriasis to greater disease severity and worse outcomes, several lifestyle factors are known to exacerbate symptom burden in patients, including obesity, smoking, and alcohol consumption.

In treating patients with psoriasis, they hypothesized that these lifestyle factors may play a potential role in the efficacy of biologic therapies, which are typically effective for many patients in the short term but are associated with ineffectiveness and subsequent discontinuation.

“As the efficacy of these agents may be negatively impacted by lifestyle factors, it is important that lifestyle risk factors are screened for and considered when selecting psoriasis medication,” noted the researchers.

Leveraging data of the 52-week phase 3 AMAGINE-2 and -3 studies investigating brodalumab, a fully human monoclonal antibody that binds with high affinity to the interleukin-17 receptor subunit A (IL-17RA), in the treatment of moderate to severe psoriasis, they conducted a post hoc analysis to evaluate the impact of obesity (body mass index ≥ 30 kg/m²), smoking, and alcohol use on brodalumab vs ustekinumab efficacy for skin clearance and patient QOL.

In the study, 929 patients with moderate to severe psoriasis treated with either brodalumab (n = 339) or ustekinumab (n = 590) were assessed for skin clearance and QOL, as measured by a 100% reduction in the Psoriasis Area and Severity Index (PASI 100) and Dermatology Life Quality Index (DLQI) score of 0/1, respectively, according to the presence of risk factors.

Overall, 85% of patients reported a history of 1 or more lifestyle risk factors. In the brodalumab and ustekinumab groups, respectively, 41.3% and 37.5% had a history of 1 risk factor, 36.0% and 40.0% had a history of 2 risk factors, and 7.7% and 9.7% had a history of 3 risk factors, respectively.

Alcohol use was indicated to be the most common risk factor in both groups (brodalumab, 59.3%; ustekinumab, 64.9%), and almost half of both patient groups were classified as obese (brodalumab, 43.4%; ustekinumab, 45.9%).

At week 52, findings showed significantly greater likelihood of complete skin clearance and improved QOL in patients treated with brodalumab vs ustekinumab regardless of the presence of lifestyle risk factors:

• No risk factors (complete skin clearance: odds ratio [OR], 2.50; 95% CI, 1.14-5.46; P = .0186; QOL: OR, 1.72; 95% CI, 0.78-3.79; P = .1883)
• One risk factor (complete skin clearance: OR, 4.64; 95% CI, 2.80-7.69; P < .0001; QOL: OR, 2.49; 95% CI, 1.54-4.02; P < .0002)
• Two risk factors (complete skin clearance: OR, 2.06; 95% CI, 1.25-3.40; P = .0045; QOL: OR, 1.57; 95% CI, 0.97-2.54; P = .0666)
• Three risk factors (complete skin clearance: OR, 2.55; 95% CI, 0.55-11.91; P = .2117; QOL: OR, 2.07; 95% CI, 0.45-9.57; P = .3438)

Furthermore, the 52-week cumulative incidence of patients achieving PASI 100 was found to be consistently higher in patients treated with brodalumab vs ustekinumab, across all risk factor subgroups (1 or 2 risk factors, P < .0001; 3 risk factors, P = .0029).

“These higher proportions of response are sustained over time,” concluded the study authors. “Thus, brodalumab may offer a good treatment option for patients with psoriasis who have a history of aggravating lifestyle risk factors.”

Reference

Kokolakis G, Vadstrup K, Hansen JB, Carrascosa JM. Increased skin clearance and quality of life improvement with brodalumab compared with ustekinumab in psoriasis patients with aggravating lifestyle factors. Dermatol Ther (Heidelb). Published online October 2, 2021. doi:10.1007/s13555-021-00618-5