A modified secukinumab dosing regimen produced outcomes on par with currently recommended intervals in patients with moderate-to-severe psoriasis, but longer follow-ups are needed to confirm the findings.
Gradually increasing the dosing interval of secukinumab (Cosentyx) produced outcomes consistent with the currently recommended dosing schedule in moderate-to-severe psoriasis and psoriatic arthritis. The modified dosing schedule also led to cost savings over a 9-month period, according to the findings of a study published in the journal Dermatologic Therapy.
Secukinumab, a recombinant, fully human monoclonal anti-IL-17A antibody, was the first IL-17A–targeting biologic to be FDA-approved for the treatment of moderate-to-severe psoriasis and psoriatic arthritis. Long-term clinical trials and real-world data have both demonstrated its efficacy in this patient group when administered subcutaneously at a dose of 300 mg weekly for 4 weeks, then administered every 4 weeks thereafter. However, whether it is feasible to gradually increase the intervals between doses has not been investigated.
The feasibility, efficacy, and safety of a gradual increase in dosing intervals was explored in the single-center, open-label, uncontrolled, prospective study. While past studies have typically increased secukinumab doses or shortened overall treatment time, changes in Psoriasis Area and Severity Index (PASI) scores were used to determine the interval durations in this study. The PASI is a widely used scale to gauge patient responses to psoriasis treatment.
A PASI 75 response indicated effective treatment, with patients showing between PASI 75 and PASI 90 responses receiving the recommended secukinumab dose every 4 weeks. Patients showing PASI 90 or better skipped a dose and were checked on after 4 more weeks.
An additional 4 weeks were added if the patient still had a PASI 90 response at follow-up, with a limit of 20 weeks between doses. Those who did not achieve PASI 75 due to prolonged treatment resumed 1 month of treatment.
A group of 83 adult patients with moderate-to-severe plaque psoriasis were recruited for the study. Participants received 4 doses of 300 mg of secukinumab subcutaneously at weeks 0, 1, 2, and 3. Starting with week 4, improvements from baseline PASI score guided injection intervals through week 36.
The modified therapy cohort showed improvement in skin lesions throughout the study. At weeks 4, 12, and 36, PASI 75 was reached by 80%, 96%, and 95% of patients, respectively. PASI 90 was reached by 54%, 95%, and 84% at weeks 4, 12, and 36, respectively. PASI 100, indicating complete clearing of skin lesions, was achieved by 28%, 89%, and 68% of patients at weeks 4, 12, and 36, respectively.
The average PASI score was 21.53 at baseline, dropped to 3.71 at week 4, hit a low of 0.59 at week 12, then rose to 1.047 at week 24. The average score was 1.38, near absence of disease and much lower than baseline, at week 36. The percentage of adverse events during the study was comparable to or less than other trials, and no new safety signals were identified in the modified treatment cohort.
The authors also note that on a typical dosing schedule, patients require 12 injections of secukinumab total, while the average number of doses in the modified regimen was 7.96 in the study. This amounts to a cost savings of $2141 per patient over the 36-week treatment period in the study.
Study limitations included a lack of control group, open-label nature, lack of randomization, and broad inclusion criteria. Still, the findings suggest a modified dosing schedule of secukinumab with gradually increasing intervals is feasible. Studies with larger cohorts and longer follow-up times are warranted to confirm that outcomes on a dosing schedule informed by treatment response are similar to outcomes on the currently recommended schedule.
Chen XB, Zheng YX, Ye LR, Chen XY, Man XY. Gradually increasing the dosing interval of Secukinumab for moderate to severe plaque psoriasis: A single-center, uncontrolled, prospective study in 36 weeks. Dermatol Ther. 2022;e15911. Published online October 9, 2022. doi:10.1111/dth.15911