Milan Tjioe, MD, PhD

Credit: dermateam.nl

Drug survival of brodalumab after patients with psoriasis switch from ixekizumab is low at a rate of 53%, according to new findings.¹

These findings were the results of a study which sought to assess the survival of brodalumab, potential reasons for discontinuing the drug, and the treatment’s side effects.

The research was authored by Milan Tjioe, MD, PhD, from the Bravis Hospital and dermaTeam Clinic in the Netherlands. Tjioe and colleagues also set out to identify determinants for drug survival, also noting the shortage of data predicting successful switches of biological treatment other than biosimilars.

“The dermatologists noticed that a large group of patients discontinued Brodalumab, and needed a reswitch,” Tjioe and colleagues wrote. “This retrospective real-world cohort study aimed to evaluate the results of this switch, with special interest in drug survival and side effects.”

Background and Findings

The investigators conducted a retrospective study at the Bravis Hospital in Bergen op Zoom and Middelburg, the Netherlands, seeking to assess the outcomes of adult patients with plaque psoriasis who were initially treated with ixekizumab and switched to brodalumab.

The study obtained approval from the institutional review board of the hospital. Inclusion criteria consisted of patients aged 18 years or older, diagnosed with plaque PsO, previously treated with ixekizumab, and had at least one follow-up visit after starting brodalumab.

Patients with psoriatic arthritis (PsA), those who had not switched from ixekizumab, or those who were biologically naive were excluded. Data was extracted from electronic medical records within a two-week window in February 2022.

Patient characteristics, baseline values of outcome measures (including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI)), treatment characteristics, and reasons for discontinuing brodalumab were collected.

Reasons for discontinuation were categorized by the research team, including primary and secondary inefficacy, side effects, or other reasons. Discontinuation decisions were made collaboratively between the physician and patient, and side effects were recorded during treatment visits and documented in their records.

The investigators included 91 electronic medical records in their study, with the majority of exclusions being due to patients not using ixekizumab prior to brodalumab (27 participants) or having a pre-existing diagnosis of psoriatic arthritis (10). Two were lost to follow-up after moving to a different hospital, 5 patients had various reasons for not switching to brodalumab.

Among the 91 included records, 62% were reported as male, and the mean duration of ixekizumab usage prior to the switch was 24.13 months. The research team also noted that the median duration of psoriasis at the start of brodalumab was found to be almost 13 years.

Baseline Psoriasis Area and Severity Index (PASI) scores were available for 36 patients, with a median score of 1.9, and the average number of previous biological treatments used was 1.3.

The investigators reported that after a single year of treatment, 32% discontinued brodalumab, with the main listed reasons being inefficacy for 22 of the participants and side effects for 4. They reported other discontinuation reasons including infections, psoriatic arthritis onset, and unrelated factors, with the most common side effect being dry skin, followed by joint pain.

The research team noted that 2 participants who reported developing joint pain were subsequently diagnosed with psoriatic arthritis. No further check-ups were enforced by the team, and data on PASI and DLQI scores were limited due to missing measurements.

However, there was a trend of higher PASI scores at baseline for the group continuing with Brodalumab and higher scores after starting treatment for the group that discontinued. DLQI comparisons were not feasible due to limited data availability, except for a single individual in the discontinued group with a DLQI score of 20.

“In conclusion, this study provides more insight on real-world nonmedical switching for PsO patients, but drug survival of Brodalumab was low in our patient group with only 53%,” they wrote. “Inadequate disease control was more important than side effects. More research is needed to provide better switching outcomes, and determinants for successful switching or choosing biologicals.”

References

1. ^{Bethlem, JC, Janssens, JAHM, Tjioe, M. Real-world drug survival of Brodalumab, in patients with psoriasis switched from Ixekizumab: results of a single centre retrospective study (BroSwitch). JEADV Clin Pract. 2023; 1– 8. https://doi.org/10.1002/jvc2.173.}