In their session, “Matching the Right Patient With the Right Therapy: The Role of IL-17 Inhibitors for Psoriasis,” presented at the 2022 Fall Clinical Dermatology Conference, April W. Armstrong, MD, MPH, and Bruce E. Strober, MD, PhD, shared insights into the roles of IL-17 inhibitors, not just in psoriasis, but other dermatologic conditions as well.

To start, Dr Armstrong introduced secukinumab, an IL-17A inhibitor that is approved for adults at 300 mg every 4 weeks. She commented that patients with obesity who struggle with efficacy could benefit from dose escalation of secukinumab by giving more frequent dosing at 2 weeks. Additionally, regarding peripheral joint disease, secukinumab was able to inhibit radiographic progression within joint narrowing or joint erosions as illustrated in a graphic that showed 84% of patients with no radiographic progression at 2 years.

Next, Dr Armstrong discussed ixekizumab, an IL-17A inhibitor approved for adults at 80 mg every 4 weeks. She showcased a study that revealed about 72% to 80% of patients taking ixekizumab will maintain clear or almost clear within 5 years.

“So, pretty good response when we’re thinking about this specific IL-17 inhibitor,” she added.

She went on to highlight a long-term comparative study between ixekizumab, brodalumab, risankizumab, guselkumab, and secukinumab that established ixekizumab at the top for cumulative benefits over a 1-year period. Just like secukinumab, ixekizumab also showed no radiographic progression.

Finally, Dr Armstrong introduced brodalumab, an IL-17A inhibitor with a maintenance dose of 210 mg every 2 weeks. She noted that brodalumab displayed a fast onset of action, drawing attention to a study in which 60% patients reached PASI 75 by week 4. In fact, brodalumab was found to achieve PASI 90 much faster than other IL-17 competitors. She added that patients who have failed treatment with secukinumab or ixekizumab could benefit from brodalumab.

For his part of the session, Dr Strober started with bimekizumab, which is an IL-17A and IL-17F inhibitor not yet approved in the United States (despite its approval around the world) for moderate to severe psoriasis, although he remarked we may see that sometime next year. He described a recent study that demonstrated patients being treated with bimekizumab reached PASI 90 by week 16, which he stated speaks favorably to long-term management because 80% of patients who reach PASI 100 at week 16 keep it up through 3 years. Regarding skin and joint responses to bimekizumab for psoriatic arthritis, there was strong efficacy at weeks 16 and 24 in a BE OPTIMAL study, in addition to a healthy control over axial disease.

He continued onto the safety profile of bimekizumab, mentioning that although serious infection and tuberculosis were of no concern, he wanted to bring attention to oral candidiasis. He said that this condition seemed to be biased toward patients taking bimekizumab compared with other IL-17 inhibitors.

Dr Strober concluded with his final thoughts on bimekizumab, reiterating its rapid response with significant efficacy in psoriasis and what is comparable to adalimumab for psoriatic arthritis (again, unapproved), in addition to strong efficacy for nail psoriasis. He emphasized its low signal for malignancy and serious infection and indicated that no laboratory monitoring is needed.

Reference
Armstrong A, Strober B. Matching the right patient with the right therapy: the role of IL-17 inhibitors for psoriasis. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.