Speed of Psoriasis Treatment Response for Biologic Agents: A Review of Phase III Clinical Trials

Background: Clinical trials often focus on the efficacy of biologic agents in the treatment of psoriasis without emphasis on the speed of response. Objective: We evaluated clinical trial data to determine which biologic agents achieve the fastest treatment response. Methods: A review of phase III clinical trials of biologic agents in psoriasis was performed. Speed was determined by analyzing Psoriasis Area and Severity Index (PASI) 75/90 responder curves to estimate the point at which 50% of subjects achieved that outcome, PASI 75/90 50 . Time to achieve PASI 75/90 50 was averaged across trials. Results: Time to achieve PASI 75 50 , in weeks: brodalumab 210 mg, 3.5; ixekizumab 80 mg Q2 W, 4; secukinumab 300 mg, 5; infliximab 5mg/kg, 5.5; risankizumab 150 mg, 6; guselkumab 100 mg, 6.25; adalimumab 40 mg, 7.25; ustekinumab 45/90 mg, 7.4; certolizumab 400 mg, 7.5; tildrakizumab 100 mg, 9; etanercept 50 mg, 12.5. PASI 90 50 responder rate estimations revealed a similar trend. Conclusion: Interleukin-17 inhibitors have a more rapid treatment response compared with other classes. Although speed is important, efficacy, persistence, side effects, cost of treatment, and number of injections are all factors to consider.