Efficacy of Secukinumab Without the Initial Weekly Loading Dose in Patients With Chronic Plaque Psoriasis

P. Gisondi; M. Rovaris; S. Piaserico; G. Girolomoni

Disclosures

The British Journal of Dermatology. 2020;182(1):175-179. 

In This Article

Abstract and Introduction

Abstract

Background: Secukinumab is administered at the labelled dose of 300 mg at weeks 0, 1, 2, 3, 4 (loading dose) and every 4 weeks thereafter.

Objectives: To investigate the efficacy of secukinumab administered without the initial loading dose in patients with psoriasis.

Methods: This was a retrospective observational study including adult patients with psoriasis (n = 156) treated with secukinumab 300 mg administered either according to the labelled dose (n = 75) or without the initial loading dose (n = 81). Efficacy was evaluated by comparing the Psoriasis Area and Severity Index (PASI) 75 and PASI 90 response rates at week 8, 12, 16, 32 and 48.

Results: For patients who received the labelled dose vs. those who did not, PASI 75 response rates were achieved at week 8, 12, 16, 32 and 48 by 60% vs. 40% (P < 0·01), 72% vs. 61% (P < 0·01), 77% vs. 75%, 85% vs. 77% and 79% vs. 78%, respectively. PASI 90 responses were achieved at the same time points by 45% vs. 31% (P < 0·01), 49% vs. 40% (P < 0·01), 54% vs. 47%, 55% vs. 47% and 57% vs. 54% for those who received the labelled dose vs. those who did not, respectively. A greater proportion of patients receiving secukinumab without the loading dose discontinued treatment because of inefficacy (25% vs. 13%, P < 0·05), particularly those with body weight greater than 80 kg.

Conclusions: Secukinumab administered without the loading dose is associated with a higher proportion of primary inefficacy, and achieved inferior results compared with the labelled dose at week 8 and week 12, but showed similar efficacy thereafter.

Introduction

Secukinumab is the first in class anti-interleukin (IL)-17A monoclonal antibody approved for chronic plaque psoriasis.[1] It is administered by subcutaneous injections at the labelled dose of 300 mg at weeks 0, 1, 2, 3, 4 (loading dose) and every 4 weeks thereafter (maintenance dose).[2] This agent has demonstrated high levels of clinical efficacy with a favourable safety profile in several randomized clinical trials, including the ERASURE, FIXTURE and CLEAR studies.[3,4] In these trials, two doses of secukinumab were studied, i.e. 300 mg and 150 mg, with the clinical response being greater at the higher dose. In particular, Psoriasis Area and Severity Index (PASI) 75 response rate at week 12 was achieved by 81·6% and 71·6% of patients treated with secukinumab 300 mg and 150 mg, respectively.[3] There is an increasing amount of data on the therapeutic efficacy and safety profile of secukinumab in patients with plaque psoriasis in real-life settings.[5–9] However, clinical studies that investigate the efficacy and safety of secukinumab using a posology other than the labelled dose are lacking. The primary objective of this study was to investigate the efficacy and safety of secukinumab 300 mg administered without the initial weekly loading dose in patients with chronic plaque psoriasis.

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