Interleukin-23 and interleukin-17A play an important role in the inflammatory process of plaque psoriasis. A comparison of two agents directed against these targets in moderate to severe plaque psoriasis led to interesting results.
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As the pharmaceutical company AbbVie Inc. in a press release, the IL23 inhibitor risankizumab (Skyrizi™) [1] proved superior to the IL17A inhibitor secukinumab (Cosentyx®) [2] in this double-blind, randomized, active-controlled, open-label phase III multicenter study with regard to various primary and secondary endpoints after a treatment period of 52 weeks [3]. Subjects were randomized 1:1 to the Skyrizi™ 150 mg* (n=164) or Cosentyx® 300 mg** (n=163) condition as subcutaneous injections. The two primary endpoints were defined as non-inferiority at week 16 and superiority at week 52 with respect to PASI90. Secondary endpoints were the values of the following parameters at week 52: PASI 100, sPGA 0/1, and PASI 75.
Under treatment with risankizumab, a proportion of 74% of patients reached PASI90 at week 16, compared with only 66% in the secukinumab condition [3]. Risankizumab also met the second primary endpoint (87% PASI 90 response vs. 57% with secukinumab, p<0.001) [3]. The IL23 inhibitor risankizumab also proved superior to the IL17A inhibitor secukinumab in all measured secondary endpoints in this study, including PASI 100, PASI 75, and sPGA 0/1 at week 52 (p<0.001) [3]. The safety profile of Skyrizi™ was consistent with that of previous studies, with no new safety signals reported over the 52-week study period (4-6). The biologics Skyrizi™ (risankizumab) [1] and Cosentyx® (secukinumab) [2] are approved in Switzerland for the treatment of moderate to severe plaque psoriasis in adults. These are two of the successively expanded spectrum of interleukin-antagonistic treatment options for psoriasis patients in recent years. The two cytokines IL-23 and IL17A differ with respect to various molecular biological characteristics (Table 1).
* Condition Skyrizi™ 150 mg: 2 subcutaneous 75 mg injections each at weeks 0, 4, and 12; thereafter at 12-week intervals.
** Condition Cosentyx® 300 mg: 2 subcutaneous 150 mg injections each at week 0,1,2,3,4; thereafter at 4-week intervals.
Source: AbbVie Inc.
Literature:
- Skyrizi [Summary of Product Characteristics]. AbbVie Ltd. Available at: www.ema.europa.eu.
- Cosentyx: https://compendium.ch, last accessed 12.02.2020
- AbbVie press release: https://news.abbvie.com/news/press-releases/new-head-to-head-phase-3-data-show-skyrizi-risankizumab-superior-to-cosentyx-secukinumab-across-primary-and-all-ranked-secondary-endpoints-in-adults-with-moderate-to-severe-plaque-psoriasis-at-52-weeks.htm
- Gordon K, et al: Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. The Lancet 2018; 25; 392(10148): 650-661.
- Reich K, et al: Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet 2019; 394(10198): 576-586.
- Blauvelt A, et al: Efficacy and Safety of Continuous Q12W Risankizumab Versus Treatment Withdrawal: 2-Year Double-Blinded Results from the Phase 3 IMMhance Trial. Poster #478. 24th World Congress of Dermatology. 2019.
- Gooderham MJ, et al: Shifting the focus – the primary role of IL-23 in psoriasis and other inflammatory disorders. J Eur Acad Dermatol Venereol 2018; 32: 1111-1119.
- Girolomoni G, et al: The role of IL-23 and the IL-23/TH17 immune axis in the pathogenesis and treatment of psoriasis. J Eur Acad Dermatol Venereol 2017; 31: 1616-1626.
DERMATOLOGIE PRAXIS 2020; 30(1): 27 (published 2/22/20, ahead of print).
