Secukinumab Provides Psoriasis Skin Clearance Regardless of Psoriatic Arthritis Status

Jerry Bagel, MD

Comorbid psoriatic arthritis (PsA) may not influence the treatment of plaque psoriasis with systemic therapy secukinumab, according to new findings.

In new data presented at the American Academy of Dermatology (AAD) Virtual Meeting Experience this weekend, investigators assessing pooled outcomes from the phase 3 CLEAR and CLARITY trials observed that patients with moderate to severe plaque psoriasis treated with secukinumab fared better than those treated with ustekinumab, regardless of baseline PsA status.

The findings, from Jerry Bagel, MD, of the Psoriasis Treatment Center of Central New Jersey, is a positive indication for the approximate 30% of psoriasis patients with comorbid PsA who may be eligible for treatment with the interleukin 17A (IL-17A) inhibitor.

Bagel and colleagues assessed treatment arm differences for CLEAR and CLARITY patient outcomes in Psoriasis Area Severity Index (PASI) 75/90/100 and Investigator’s Global Assessment (IGA) 0-1 at 52 weeks.

The 2 trials originally sought to compare such psoriasis outcomes and treatment-related safety in patients with moderate to severe disease treated with either 300 mg secukinumab or ustekinumab.

The new assessment of the pooled data took into consideration the prevalence of rheumatologist-confirmed PsA at baseline, with treatment arm differences assessed via logistic regression analysis with nonresponder imputation.

Among the 1778 assessed patients, 346 (19.5%) had baseline PsA. Patients with both psoriasis and PsA were generally older, more likely to be female, and with more instances of prior systemic and/or biologic therapy use. Additionally, their time since psoriasis diagnosis had been longer than those without PsA.

Investigators observed that patients treated with secukinumab were more likely to achieve PASI 75/90/100 responses and IGA improvement at 52 weeks than those administered usetkinumab, regardless of their PsA status.Secukinumab-treated patients with and without PsA reported consistent rates of PASI 90 (72.1% vs 71.2%), PASI 100 (32.5% vs 33.7%), and IGA 0 or 1 (70.4% vs 74.6%; P <.005).

Among ustekinumab-treated patients with and without PsA, PASI 90 (52.1% vs 59.8%), PASI 100 (32.5% vs 33.7%), and IGA 0 or 1 (48.5% vs 61.2%) rates were more favorable to patients with lone psoriasis at baseline (P <.005).

Regarding safety, investigators observed a similar of adverse event frequencies across all treatment arms stratified by patient PsA status at baseline.

The team concluded that the IL-17A inhibitor therapy was associated with improved psoriasis marks without difference in consideration to the often prevalent comorbidity of psoriatic arthritis, versus ustekinumab.

“Secukinumab treatment improved skin psoriasis signs to a greater extent than ustekinumab, regardless of presence or absence of PsA at baseline,” they wrote.

The study, “Presence of Psoriatic Arthritis Has No Impact on the Clinical Efficacy and Safety of Secukinumab in Patients With Psoriasis: Pooled Analysis of the Phase 3 CLEAR and CLARITY Trials,” was presented at AAD VMX.