COPENHAGEN – It is worthwhile to push harder for complete skin clearance in a psoriasis patient whose treatment regimen provides a Physician Global Assessment score of 1, or “almost clear,” according to Dr. Kristian Reich.
He presented an analysis of pooled data from the active treatment arms of three 12-week phase III clinical trials of the investigational interleukin-17 inhibitor brodalumab. The 1,260 patients with a static Physician Global Assessment (PGA) score of 1, or almost clear, at week 12 had significantly greater residual disease in terms of involved body surface area, fewer symptom-free days, and greater health-related quality of life impairment than did the 1,097 participants who achieved a static PGA of 0.
Dr. Kristian Reich
“These results suggest that clear versus almost clear represents meaningfully different levels of disease,” Dr. Reich of Dermatologikum Hamburg (Germany) said at the annual congress of the European Academy of Dermatology and Venereology.
The newer-generation biologics that target IL-17 or IL-23 provide a significantly greater rate of complete skin clearance than do the older anti–tumor necrosis factor biologic agents. But the newer biologics are also typically costlier and have a shorter safety record. So the question arises: Does the residual disease that defines a static PGA of 1 matter to patients in terms of quality of life and days free of symptoms? Or do they want even better results, if achievable? This is what Dr. Reich and his coworkers set out to answer.
Thirty percent of patients with a static PGA of 1 had clinically significant residual disease at week 12 as defined by a body surface area involvement of 6% or greater, as did 0.3% of those with a static PGA of 0. Fourteen percent of patients with a static PGA of 1 had a Dermatology Life Quality Index score of 6 or more, indicative of at least moderate impairment in quality of life, compared with 6.4% of psoriasis patients with a static PGA of 0.
Moreover, 42% of patients with a static PGA of 0 were 100% symptom free every day from week 10 to week 12 of the study as defined by a score of 0 on the eight-item Psoriasis Symptom Inventory, compared with 12% of patients with a static PGA of 1.
Dr. Reich reported receiving research support from Amgen, which funded the study.