Journal of Clinical and Aesthetic Dermatology

Plaque-type Psoriasis Supplement 2016

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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A Novel Paradigm for Treatment of Moderate-to-severe Plaque-type Psoriasis [JUNE 2016 • VOLUME 9 • NUMBER 6 • SUPPLEMENT 1] SUPPLEMENT TO THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY S9 etanercept and 15 percent of patients randomized secukinumab and placebo had psoriatic arthritis. Between 11 and 14 percent of patients were previously on a biologic in the FIXTURE study. Outcomes. Coprimary endpoints and key secondary endpoints. Overall, secukinumab was superior to placebo in all of the coprimary and key secondary endpoints; secukinumab was also superior to etanercept with respect to all key secondary endpoints. Similar to the ERASURE study findings, the 300mg dose of secukinumab showed numerically superior response rates compared to the 150mg dose. Specifically in the FIXTURE study, at the end of 12 weeks, the PASI 75 rates were 77.1 percent in the secukinumab 300mg arm, 67.0 percent in the secukinumab 150mg arm, 44.0 percent in the etanercept arm, and 4.9 percent in the placebo arm (P<0.001 for each secukinumab dose vs. comparators). The proportion of patients with an IGA score of 0 or 1 was significantly higher in each of the secukinumab doses compared to both etanercept and placebo (P<0.001 for each secukinumab dose vs. comparators). With regard to key secondary endpoints, significantly greater proportions of patients in both doses of secukinumab achieved DLQI of 0 or 1 at Week 12 compared to the etanercept or placebo group (P<0.001 for all comparisons). One key secondary endpoint is assessing the speed of response during the induction period (Figure 2). The investigators found that the median time to a 50- percent reduction in PASI from baseline was significantly shorter in both doses of secukinumab (3 weeks for 300mg secukinumab and 4 weeks for 150mg secukinumab) compared to etanercept (7 weeks) (P<0.001 for both comparisons). With regard to maintenance (Figure 3), the rates of response with regard to achievement of PASI 75, 90, and 100 and IGA of 0 or 1 were higher with secukinumab than etanercept through Week 52. Safety. During both the induction and treatment periods of the FIXTURE study, the rates of adverse events were overall similar between the secukinumab and etanercept groups. The most common adverse events in the secukinumab groups were nasopharyngitis, headache, and diarrhea. Some differences were observed in adverse event rates between secukinumab and etanercept. Though not statistically significant, the rate of injection-site reaction was numerically lower in the secukinumab groups (0.7%) compared to etanercept (11%). Candida infections were Figure 1. Efficacy through Week 52 in the ERASURE study. This figure shows the maintenance of response with regards to PASI 75, 90, and 100, and IGA 0 or 1 in secukinumab 300mg and 150mg through Week 52. Adapted from Langley et al. N Engl J Med. 2014;371(4):326–338.

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