Onset of Plaque Psoriasis Treatment Responses With Anti-IL-17/IL-23 Biologic Therapies

August 2022 | Volume 21 | Issue 8 | 854 | Copyright © August 2022


Published online July 29, 2022

Richard G. Fried MD PhDa, Mark Lebwohl MDb, Miriam Bettencourt MDc, John Koo MDd, Abby Jacobson MS PA-Ce

aYardley Dermatology Associates, Yardley, PA
bIcahn School of Medicine at Mount Sinai, New York, NY
cUniversity of Nevada, Las Vegas, NV
dUniversity of California San Francisco Psoriasis and Skin Treatment Center, San Francisco, CA
eOrtho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, NJ

Abstract
Background: The impact of psoriasis on quality of life arises from both physical symptoms, such as pain and pruritus, and the psychosocial effects of the often highly visible lesions. For patients with moderate-to-severe psoriasis seeking amelioration of these symptoms, time to onset of treatment response is an important consideration when determining an appropriate therapeutic approach with their healthcare provider.
Methods: In this review, we discuss the fluidity of the definition of rapid response and time-to-response expectations of patients with psoriasis receiving biologic therapies. Next, we focus on time to response of brodalumab, a human anti–interleukin-17 receptor A monoclonal antibody, in patients with moderate-to-severe psoriasis, as measured by the psoriasis area and severity index and the psoriasis symptom inventory. Brodalumab previously exhibited efficacy and safety in treatment of moderate-to-severe psoriasis in three phase 3 trials (AMAGINE-1/-2/-3), warranting further characterization of its ability to meet patient needs regarding rapidity of treatment response. Finally, we place time to response of brodalumab in the context of the current treatment landscape of biologic therapies for psoriasis (particularly those targeting the interleukin-17/interleukin-23 axis).
Results: Direct and indirect comparisons with other interleukin-targeting drugs support brodalumab’s more rapid onset of treatment effects, including skin clearance and relief of itch and pain.
Conclusion: Brodalumab induces a rapid treatment response in patients with moderate-to-severe psoriasis and may promote earlier improvements in quality of life.

J Drugs Dermatol. 2022;21(8):854-860. doi:10.36849/JDD.6791

INTRODUCTION

Psoriasis is a chronic inflammatory skin condition affecting 2% to 3% of the world's population.1,2 The development of the characteristically pruritic plaques is driven by complex immune processes. Although topical therapies are among the first-line treatment options for mild psoriasis, many patients require phototherapy or systemic treatment, including oral and biologic drugs.3 Treatment options differ not only in their mechanisms of action and side-effect profiles but also in the time needed to achieve treatment results. When evaluating differences in the time to treatment response, it is important to consider the profound effect that psoriasis can have on health and quality of life, as well as how that may shape patient expectations and preferences regarding response time.

Mental health comorbidities of psoriasis are well established. In patients with psoriasis, depressive symptoms may emerge from a combination of chronic physical pain and discomfort and the social stigma attached to the appearance of skin lesions.4 Additionally, studies have suggested that the inflammatory milieu of psoriasis may be a causative link to depression.5 In a 2008 survey, 63% of individuals with psoriasis reported significant self-consciousness, and more than one-third reported avoiding social activities because of their psoriasis.6 For some patients, this psychosocial distress may occur alongside symptoms of clinical depression. For example, one large population analysis found that 28% of individuals with psoriasis experienced depressive symptoms and were 1.5 times more likely to have clinical depression compared with the general population.7 In a study of >2000 patients with psoriasis, 62% experienced some symptoms of depression.8 Although the etiology of depression in patients with psoriasis is complex, studies have shown statistically significant correlations between disease flares and