Adam Reich, PhD

Credit: sciforschenonline.org

Anti-interleukin (IL)-17A biologics—ixekizumab particularly—lead to fast and sustained improvements in psoriasis patients compared with other biologics, according to new findings.¹

The importance of objective measures evaluated by dermatologists, such as Psoriasis Area and Severity Index (PASI), are known to be given more priority in clinical trials, while subjective measures and treatment response speed are given less importance.²

This research was conducted due to limited current patient-reported assessments of disease impacts on health-related quality of life (HRQoL).³ Incorporating patient perspectives in decision-making for treatment is known to increase patient satisfaction and HRQoL outcomes.⁴

The study was authored by Adam Reich, PhD, from the Institute of Medical Sciences’s Department of Dermatology at Medical College of Rzeszow University in Poland.

Reich and colleagues sought to “compare the speed of clinical improvement of approved biologics on the symptoms and signs of psoriasis assessed by patients using the validated Psoriasis Symptoms and Signs Diary (PSSD) through 12 weeks.”

Background and Findings

The investigators conducted the Psoriasis Study of Health Outcomes (PSoHO), which they note was an observational study conducted on an international scale, aimed at comparing the effectiveness of anti-IL-17A biologics with other biologics. They also compared ixekizumab with 5 different biologics individually in psoriasis patients.

Patients were asked by the investigators to evaluate their psoriasis symptoms and signs, such as itching, burning, skin tightness, stinging, dryness, shedding/flaking, redness, scaling, pain, and bleeding through the use of the PSSD 7-day recall period scale ranging from 0 - 10. The individual scores were then used to calculate summary scores for both symptoms and signs, ranging from 0 - 100.

The research team evaluated the percentage change in summary scores and the proportion of patients who experience clinically meaningful improvements in their summary and individual scores each week. They reported longitudinal PSSD data as observed, with the treatment comparisons analyzed using mixed models for repeated measures (MMRM) and generalized linear mixed models (GLMM).

The investigators ended up with 1654 eligible patients recruited who showed comparable baseline PSSD scores across cohorts and treatments. Overall, they noted that the anti-IL-17A cohort showed significantly larger score improvements in PSSD summary scores and a higher proportion of patients showed CMIs compared to the other biologics cohort from week 1 through 12 weeks.

Additionally, the research team noted that participants reporting lower PSSD scores were associated with a greater proportion of patients reporting their psoriasis as no longer impacting their quality-of-life (DLQI 0,1) and a high level of clinical response (PASI100). The team reported the finding of a relationship between an early CMI in PSSD score at week 2 and PASI100 score at week 12.

“In conclusion, treatment with anti-IL-17A biologics, and particularly IXE, resulted in rapid and sustained patient-reported improvements in psoriasis symptoms and signs compared with other biologics in a real-life setting,” they wrote. “This rapid clinical improvement resulted in a greater proportion of patients reporting a longer treatment period, during which they were less burdened by the symptoms and signs of psoriasis.”

References

1. ^{Reich A, Pinter A, Maul JT, et al. Speed of Clinical Improvement in the Real-World Setting from Patient-Reported Psoriasis Symptoms and Signs Diary (PSSD): Secondary Outcomes from the Psoriasis Study of Health Outcomes (PSoHO) Through 12 Weeks. J Eur Acad Dermatol Venereol. 2023 May 5. doi: 10.1111/jdv.19161. Epub ahead of print. PMID: 37147855.}
2. ^{Papp KA, Blauvelt A, Kimball AB, Han C, Randazzo B, Wasfi Y, et al. Patient- reported symptoms and signs of moderate-to-severe psoriasis treated with guselkumab or adalimumab: results from the randomized VOYAGE 1 trial. Journal of the European Academy of Dermatology and Venereology. 2018;32(9):1515-22.}
3. ^{Lebwohl MG, Bachelez H, Barker J, Girolomoni G, Kavanaugh A, Langley RG, et al. Patient perspectives in the management of psoriasis: results from the population- based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. Journal of the American Academy of Dermatology. 2014;70(5):871-81. E30.}
4. ^{Umar N, Litaker D, Schaarschmidt M-L, Peitsch WK, Schmieder A, Terris DD. Outcomes associated with matching patients' treatment preferences to physicians' recommendations: study methodology. BMC health services research. 2012;12(1):1-10.}