Onset of Action of Antipsoriatic Drugs for Moderate-to-Severe Plaque Psoriasis: An Update

March 2019 | Volume 18 | Issue 3 | Original Article | 229 | Copyright © March 2019

Christopher J. Yao MPH,a,b Mark G. Lebwohl MDb

aUniversity of Rochester School of Medicine and Dentistry, Rochester, NY


Objectives: The time that drugs for moderate-to-severe psoriasis take to see a clinically meaningful improvement (TOA) is one of the most important attributes of treatment success. This study synthesizes TOA data from previously reviewed drugs and adds clinical data for tidrakizumab and certolizumab pegol for comparison

Methods: We reviewed published and presented efficacy data regarding TOA, which was defined as the time at which 25% of the sample population reached Psoriasis Area and Severity Index (PASI) 75 or the time at which the sample population reached a mean PASI 50.

Results: Antipsoriatic drugs obtained clinically meaningful outcomes within 1.8-25.4 w, and brodalumab had the fastest TOA for both outcome measures.

Conclusion: Brodalumab may continue to have the most rapid onset of action of available antipsoriatic therapies.

J Drugs Dermatol. 2019;18(3):229-233.


Psoriasis vulgaris is an inflammatory skin disease characterized by quickly thickening and scaling plaques affecting the skin and nails,1 which can cause discomfort, pain, and social distress2 for the 1 to 2 percent of the American population3,4 and 2 to 3 percent of the global population5,6 that suffer from the disease. The advent of new biologic therapies has improved the quality of life of patients with moderate-to-severe psoriasis,7 and rapid disease improvement has been rated to be among the most important attributes of treatment success.8 Two studies have reviewed the time for patients to achieve clinically meaningful improvements (TOA) measured by the Psoriasis Area and Severity Index (PASI) with various antipsoriatric drugs.9,10 However, neither review is up-to-date with clinical data for certolizumab pegol and tildrakizumab.This review aims to synthesize data from previous TOA reviews for antipsoriatic drugs, update these analyses with clinical data of tildrakizumab and certolizumab pegol, and add recently published clinical data on apremilast and low-dose acitretin.


Identification of StudiesWe consolidated clinical data from recent publications and presentations of certolizumab pegol (CZP), tildrakizumab, apremilast, and low-dose acitretin as well as two previous TOA reviews. The first was a systematic review that identified trials performed according to the German S3 psoriasis guidelines10,11  and grouped data on study arms where comparable dosages and outcome criteria were used and then reported weighted means by considering the number of patients in each study arm and assuming a linear course of PASI response between provided timepoints.10 An update to this review compared the TOA for these antipsoriatic drugs with clinical data for brodalumab, secukinumab, ustekinumab, and ixekizumab from individual studies or pooled data where TOA had already been calculated by linear interpolation or Kaplan-Meirer estimation.9 Clinical data from both these TOA reviews were combined with clinical data for CZP from CIMPASI-1 and CIMPASI-212 as well as CIMPACT13 trials obtained from UCB, clinical data for tildrakizumab from reSURFACE 1 and reSURFACE 2 trials14 obtained from Sun Pharma, and published data for apremilast15 and low-dose acitretin.16 In our analysis of clinical data not previously reviewed, we also assumed a linear course of the PASI response between the different measured time points in order to perform linear interpolation.10Primary and Secondary OutcomesThe primary outcome of our review was the time necessary for 25% of patients in a study population to achieve at least a Psoriasis Area and Severity Index (PASI) 75 response. The secondary outcome of our review was the time necessary for a study population to achieve a mean PASI 50 response. While there are more than 50 clinical measures that can be used to measure psoriasis severity such as DLQI (Dermatology Life Quality In