Researcher Excited About Future of Psoriasis Treatment

When Boni Elewski, MD, was in medical school in the 1970s, patients with psoriasis were treated with monthlong hospital stays, coated with coal tar medications and then given ultraviolet light therapy.

The progression from then to today, where patients can be treated with injectable medications, has left the University of Alabama at Birmingham physician, who was drawn to dermatology because of a family history with the disease, enthusiastic about the future of psoriasis treatment.

“It’s much more than a rash,” said Elewski in an interview with The American Journal of Managed Care^® (AJMC^®). “These people may have social issues because they are being ridiculed. I have patients that they don’t allow in swimming pools.”

More than 8 million Americans have psoriasis; Elewski’s father and his sister, her aunt, were one of them.

Elewski was the lead author of a recently published study looking at phase 3 results about the sustained results achieved with tildrakizumab (approved last year by the FDA and marketed under the name Ilumya) in patients with moderate to severe psoriasis.¹ Tildrakizumab is a biologic that blocks interleukin-23 (IL-23) and is given by injection every 12 weeks.

The trial looked at whether efficacy at week 28 can be sustained or improved by week 52. Patients from a previous trial on either 100 mg or 200 mg tildrakizumab in the first 52 weeks achieving a psoriasis area severity index (PASI) score of 50 (meaning they were 50% clear of skin lesions) were pooled from 2 phase 3 randomized controlled trials, and grouped into 4 four mutually exclusive week-28 PASI response groups. Their PASI scores at week 52 were compared with their PASI scores at week 28.

Of 352 patients receiving 100-mg tildrakizumab, 10.5%, 25.3%, 38.4%, and 25.9% achieved PASI 50—74, 75–89, 90–99, and 100 at week 28, respectively.

Among patients achieving PASI 90, PASI 75, or PASI 50 at week 28, 89.4%, 91.1%, or 97.4% maintained their week-28 PASI responses at week 52, respectively.

Interestingly, the percentage of patients who demonstrated improved PASI response from week 28 to week 52 was higher in those whose initial response was on the lower side; ie, partial responders (PASI 50—75: 53–65%) or responders (PASI 75–89: 34–41%) than in super-responders (PASI 90–99: 25–33%).

Elewski said that the results demonstrate how psoriasis is “a marathon, not a sprint.” “Even if you have not cleared by week 28, you have a high chance of clearing by the end of the first year,” she said.

It suggests that psoriasis patients with a partial response at an earlier treatment stage may achieve higher responses by maintaining the same dose of tildrakizumab. It also hints that tildrakizumab works differently in different people, Elewski said. But many patients become clear after just 1 or 2 injections, she said.

“I think we’re in a very exciting time in medicine, where we’re giving precision medicine, the right drugs for the right patients,” said Elewski.

Reference

Elewski B, Menter A, Crowley J, et al. Sustained and continuously improved efficacy of tildrakizumab in patients with moderate-to-severe plaque psoriasis [published online July 22, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1640348.