Early Secukinumab Treatment Linked With Lasting Psoriasis Control

Patients with newly diagnosed moderate to severe plaque psoriasis who received early treatment with the interleukin (IL)-17 inhibitor secukinumab maintained skin clearance for up to a year after stopping therapy in a subset of cases, according to findings from the STEPIn trial (NCT03020199) published in the Journal of the American Academy of Dermatology.¹ The results added to growing evidence that intervening earlier in the disease course may alter long-term outcomes for some patients with psoriasis.

The randomized, open-label, multicenter STEPIn study (NCT03020199) evaluated whether early biologic intervention could produce durable disease control after treatment withdrawal in patients with new-onset plaque psoriasis.

Disease recurrence remains a persistent challenge in psoriasis management, particularly after systemic therapy is discontinued. A 2022 systematic review published in the American Journal of Clinical Dermatology found that relapse commonly occurred following withdrawal of biologic and systemic treatments, although the timing varied substantially by therapeutic class and individual patient factors.²

The review highlighted that many patients experienced recurrence within months of treatment cessation, underscoring the chronic and relapsing nature of psoriasis and the difficulty of maintaining long-term disease control off therapy.¹ These findings have contributed to growing interest in whether earlier intervention with biologic therapy could alter inflammatory disease pathways before long-standing immune “memory” becomes established, potentially prolonging remission and reducing the likelihood of relapse after treatment withdrawal.

Investigators enrolled adults with moderate to severe plaque psoriasis whose disease duration was 1 year or less and who had not previously received systemic therapy or phototherapy. Patients were randomized to receive either secukinumab 300 mg or narrow-band ultraviolet B (nb-UVB) phototherapy for 52 weeks, followed by a treatment-free observation period through week 104.

Researchers said the study addressed a gap in psoriasis research, which has historically focused on patients with longstanding disease. In pivotal secukinumab trials such as ERASURE and FIXTURE, the average disease duration was approximately 17 years, whereas evidence supporting early intervention in psoriasis remained “limited and inconsistent,” according to the authors.

Among the 77 patients randomized to secukinumab, 93.5% completed the initial 52-week treatment period compared with 59.2% of the 76 patients assigned to nb-UVB. Investigators reported that 66 patients in the secukinumab group entered the treatment-free follow-up phase after achieving at least 50% improvement in Psoriasis Area and Severity Index (PASI) scores at week 52.

At week 104, 20.8% of patients previously treated with secukinumab maintained PASI 90 responses despite having discontinued therapy for 1 year. Investigators also reported sustained PASI 100 responses in 11.7% of patients, while 22.1% maintained Investigator’s Global Assessment modified 2011 scores of 0 or 1. Additionally, 24.7% of patients maintained PASI scores below 3 at week 104.

The study also examined relapse after treatment discontinuation. Investigators defined relapse as loss of 50% of maximal PASI improvement following treatment cessation. Among patients who entered the treatment-free follow-up period after secukinumab treatment, 44% did not relapse between weeks 52 and 104. For patients who did relapse, the mean time to relapse was 32 weeks after treatment withdrawal.

Patient-reported outcomes suggested that improvements in quality of life and symptoms persisted in some participants after treatment discontinuation. At week 104, 19.5% of patients maintained Dermatology Life Quality Index scores of 0 or 1, indicating little or no impact of psoriasis on quality of life. Investigators also observed reductions in pain, itching, and scaling scores through the follow-up period.

The authors noted that patients with the shortest disease duration appeared to experience greater benefit. In subgroup analyses, patients with a psoriasis disease duration shorter than 6 months achieved numerically higher PASI 90 response rates at week 104 compared with those whose disease duration ranged from 6 to 12 months, although the difference did not reach statistical significance.

Investigators compared the STEPIn findings with prior secukinumab trials conducted in patients with longstanding psoriasis. They reported that 91.1% of patients in the STEPIn trial achieved a PASI 90 response at week 52 compared with 72.8% of patients in the earlier ERASURE (NCT01365455) and FIXTURE (NCT01358578) trials.

The authors wrote that “patients with shorter disease duration demonstrated markedly higher PASI 90 response rates with secukinumab compared to those with long-standing disease, reinforcing the clinical value of initiating therapy early.”

Researchers also suggested the findings could support the concept of disease modification in psoriasis. They cited mechanistic data from a STEPIn substudy showing that secukinumab normalized DNA methylation differences in lesional skin from patients with new-onset psoriasis, whereas residual epigenetic changes persisted in patients with longstanding disease.

Still, investigators cautioned against overinterpreting the findings. The study’s open-label design represented a key limitation, and dropout rates were substantially higher in the nb-UVB group because of lack of efficacy and other factors. That imbalance introduced selection bias during the treatment-free follow-up phase, limiting direct comparisons between treatment groups after week 52.

In their conclusion, the authors stated that the findings “support a change in the management of patients with moderate to severe plaque PsO towards proactive early intervention.”

References

1. Iversen L, Langley RG, Gudjonsson JE, et al. Impact of early treatment of psoriasis on disease recurrence-results from the STEPIn study. J Am Acad Dermatol. Published online March 23, 2026. doi:10.1016/j.jaad.2026.03.050

2. Regnault MM, Shourick J, Jendoubi F, Tauber M, Paul C. Time to relapse after discontinuing systemic treatment for psoriasis: a systematic review. Am J Clin Dermatol. 2022;23(4):433-447. doi:10.1007/s40257-022-00679-y