Efficacy and Safety of Secukinumab in the Treatment of Psoriasis in Patients with Skin Phototypes IV to VI

August 2024 | Volume 23 | Issue 8 | 8128 | Copyright © August 2024


Published online July 24, 2024

Nour El-Kashlan MDa, Ahuva Cices MDa, Bridget Kaufman MDa, Joel Correa Da Rosa PhDa, Ingrid Sanabria-Gonzalez AAa, Saakshi Khattri MDa, Andrew Alexis MD MPHb

aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bDepartment of Dermatology, Weill Cornell Medicine, New York, NY

Abstract
Background: There is a paucity of data on the treatment of psoriasis in patients with skin of color – a diverse population among whom variations in clinical features and higher quality of life impact have been reported. This single-center, open-label clinical study evaluated the safety and efficacy of secukinumab in the treatment of moderate-to-severe plaque psoriasis in adults with Fitzpatrick skin types IV-VI.
Methods: A total of 20 male and female subjects (ages ≥ 18, BSA ≥10%, PASI Score ≥ 12, IGA ≥ 3) completed this study. The total study duration was 28 weeks. During the treatment period, subjects received secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4, then monthly through week 20.
Results: 73% of patients achieved at least 90% improvement in PASI score (PASI90) at week 16 compared to baseline (P=0.0592). There was a statistically significant proportion of patients achieving PASI75, IGA of clear or almost clear, and a change from baseline in DLQI total score at weeks 12, 16, and 24. A statistically significant reduction in IGAxBSA-75 score was achieved between week 16 and baseline.
Limitations: The sample size was small and underpowered to detect statistically significant changes in some endpoints. Furthermore, the study period was interrupted by the COVID-19 pandemic, which contributed to numerous missing data points.
Conclusion: Secukinumab 300 mg administered monthly was safe, well-tolerated, and efficacious in treating skin of color patients with psoriasis and improving health-related quality of life. Larger studies involving skin of color populations with psoriasis are warranted.

J Drugs Dermatol. 2024;23(8): doi:10.36849/JDD.8128

INTRODUCTION

Psoriasis is a chronic inflammatory disorder primarily affecting the skin and joints. It affects different racial/ethnic groups worldwide with varying prevalence. Although psoriasis has historically been considered to predominately affect populations who self-identify as White, recent data shows substantial rates of psoriasis in patients with skin of color.1,2 The 2011 to 2014 National Health and Nutrition Examination Surveys estimate the prevalence of psoriasis to be 3.6% of White, 1.5% of African American, and 1.9% of Hispanic adults aged 20 to 59.1 However, the true prevalence of psoriasis in Black/African American and Hispanic populations may be higher than suggested due to potential under-diagnosis and under-reporting.3,4

Classically, plaque psoriasis presents as well-demarcated erythematous plaques with an overlying micaceous scale. However, it is important to note nuances in the clinical presentation of psoriasis in patients of skin of color. Black patients with psoriasis tend to have less discernable erythema and/or erythema that appears more violaceous or hyperchromic, thicker plaques with more scale, and greater body surface area involvement compared to White patients, and increased incidence of postinflammatory pigmentary alteration, which may be more bothersome to patients than the disease itself.5-10

Psoriasis in skin of color patients has been linked to a greater psychosocial impact and worse quality of life (QOL) compared to psoriasis in White patients as evidenced by consistently
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