Secukinumab Dose Tapering Maintains Efficacy Treating Plaque Psoriasis

Tapering off dosages of secukinumab might be equally efficacious as previous regimens for patients with plaque psoriasis.

A team, led by Xi-Bei Chen, Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, assessed the feasibility, efficacy, and safety of gradually increasing the secukinumab dosing interval in patients with plaque psoriasis.

The Drug: Secukinumab

Secukinumab is a recombinant, fully human monoclonal anti-IL-17A antibody currently approved for the US Food and Drug Administration (FDA) for the treatment of patients with moderate-to-severe psoriasis and psoriatic arthritis.

While past research have resulted in positive effectiveness and safety data, a gradual increases in secukinumab dosing interval has not previously been studied.

Inclusion Criteria

In the study, the investigators determined the interval duration of 83 patients by changes in the Psoriasis Area and Severity Index (PASI) scores. Each participant was treated with secukinumab 300 mg subcutaneously at baseline and weeks 0, 1, 2, and 3. Each participant was aged at least 18 years with moderate-to-severe plaque-type psoriasis for at least 6 months, with or without psoriatic arthritis.

Prior treatments included among the patient population were topical, systemic, phototherapy, or biologic therapy alone or in combination.

Patients treated previously with biologics had at least a 1 month washout period.

The investigators defined moderate-to-severe plaque-type psoriasis as a PASI score ≥ 10 or body surface area (BSA) ≥ 10%.

Tapering Doses

Patients with an improvement from baseline PASI at week 4 guided the next injection time until week 36.

During the study, 3 patients were censored and 6 patients switched to biologic therapy because of continuous therapeutic resistance. Of this group, 2 patients terminated therapy at week 12, 1 at week 24, and 3 at week 36.

The mean time from the first diagnosis of psoriasis was 24.8 years and the mean duration of psoriasis was 14.84 years. In addition, a mean baseline PASI score of 21.53 and a mean baseline BSA score of 47.76 indicated the severity of disease.

PASI 75 was achieved by 80%, 96%, and 95% of patients at weeks 4, 12, and 36, respectively, while PASI 90 was achieved by 54%, 95%, and 84% of patients at weeks 4, 12, and 36, respectively.

Finally, PASI 100 was achieved by 28% of patients in week 4, 89% in week 12, and 68% in week 36.

The average PASI score was lower at week 36 than it was at baseline and the majority of patients reached PASI 75 at week 36.

For safety, 28 participants suffered adverse events, including 10 infections (nasopharyngitis, fungal infection, conjunctivitis, otitis externa), pruritus (n = 5), eczema (n = 4), headache (n = 1), and inflammatory bowel disease (n = 1).

All of the adverse events were considered mild severity, easily manageable, and did not result in drug discontinuation outside of the case of IBD, which was moderate and led to treatment discontinuation.

“Our modified study outcomes illustrate a similar efficacy as previous studies,” the authors wrote. “Overall, the safety and efficacy of our tapering dose regimen were consistent with those of the previously recommended dose.

“This study demonstrates the feasibility of gradually increasing the dosing interval of secukinumab and may serve as a reference for biologic treatment experience, although a longer follow-up time and expanded sample sizes are necessary to investigate this possibility.”

The study, “Gradually increasing the dosing interval of Secukinumab for moderate to severe plaque psoriasis: A single-center, uncontrolled, prospective study in 36 weeks,” was published online in Dermatologic Therapy.