Psoriasis Review: Psoriasis Research Among Top News at AAD

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Experts who presented at 2018 American Academy of Dermatology Annual Meeting reviewed long-term data for several psoriasis treatments and discussed recent and new drugs in development. 

More than18,000 people—including about 4800 physicians—attended the 5-day program held in San Diego, California, that provided dermatologists with a comprehensive update on the diagnosis and treatment of the wide range of conditions seen in daily practice. 

Following are some highlights in therapeutic advances in the psoriasis area.

Ustekinumab Significantly Reduces Aortic Inflammation  

Results from a recent study1 demonstrated that participants with psoriasis who received ustekinumab (Stelara) experienced a 19% improvement in aortic inflammation compared with those who received placebo, according to Joel M. Gelfand, MD, MSCE. 

“This is the first placebo-controlled trial of a biologic drug to show a benefit in aortic inflammation, a key marker of cardiovascular disease,” Dr Gelfand said. “The effect is similar to what we would expect if we put the patient on a statin.”2

The randomized, double-blind, placebo-controlled trial was conducted by Dr Gelfand and researchers at the Perelman School of Medicine at the University of Pennsylvania in collaboration with the National Heart, Lung, and Blood Institute. In the study, participants were randomized to placebo (n=21) or ustekinumab (n=22). Aortic inflammation was measured at baseline and at week 12 using fluorodeoxyglucose-positron emission tomography and computed tomography scans.

Overall, participants who received ustekinumab experienced a 6.6% decrease in aortic inflammation, whereas participants who received placebo experienced a 12% increase in inflammation. 

Additionally, 77% of participants who received ustekinumab experienced improvements in skin inflammation compared with 10.5% of participants who received placebo. 

“This study represents promise that this treatment may reduce the risk of heart attack and stroke in the future. It’s an encouraging finding,” Dr Gelfand concluded. 

References

1. Gelfand JM, et al. A phase IV, randomized, double-blind, placebo-controlled crossover study of the effects of ustekinumab on vascular inflammation in psoriasis (The Vip-U Trial). Presented at: 2018 American Academy of Dermatology Annual Meeting; February 16-20, 2018; San Diego, CA.

2. Drug that treats psoriasis also reduces aortic vascular inflammation [press release]. Philadelphia, PA: University of Pennsylvania School of Medicine; February 16, 2018. https://www.pennmedicine.org/news/news-releases/2018/february/drug-that-treats-psoriasis-also-reduces-aortic-vascular-inflammation. Accessed February 21, 2018. 

psoriasis

Investigational Risankizumab Superior to Ustekinumab for Plaque Psoriasis

Kenneth Gordon, MD, and colleagues presented results from 2 phase 3 trials that showed risankizumab was superior to ustekinumab (Stelara) for treating patients with moderate to severe plaque psoriasis. 

“Not only do these data show significant rates of clear skin, but because we know the burden of psoriasis extends beyond the skin, we are encouraged by the patient-reported improvement in quality of life after 1 year of treatment,” said Dr Gordon, chair of the department of dermatology at the Medical College of Wisconsin and principal investigator of the ultIMMa-1 study. 

The ultIMMa-1 and ultIMMa-2 replicate clinical trials assessed the safety and efficacy of risankizumab compared with ustekinumab and placebo. In ultIMMa-1, 304 participants were randomized to 150 mg of risankizumab and 100 participants were randomized to 45 mg or 90 mg of ustekinumab based on their weight. ultIMMa-2 included 294 participants who were randomized to 150 mg of risankizumab and 99 participants who were randomized to 45 mg or 90 mg of ustekinumab.

Primary endpoints included the achievement of at least a 90% improvement in Psoriasis Area and Severity Index (PASI 90) score at week 16 and achievement of a static Physician’s Global Assessment (sPGA) score of 0 or 0/1 (clear or almost clear skin) at week 16 compared with placebo. In addition, PASI 90, sPGA score of 0, sPGA score of 0/1, and Dermatology Life Quality Index (DLQI) score of 0 or 1 were compared between risankizumab and ustekinumab at week 16 and week 52. 

After 16 weeks of treatment, 37% and 51% of participants who received risankizumab in ultIMMa-1 and ultIMMa-2, respectively, achieved sPGA 0 compared with those who received ustekinumab (ultIMMa-1: 14%; ultIMMa-2: 25%). Clear skin was achieved by 58% of participants in ultIMMa-1 and 60% of participants in ultIMMa-2 after 1 year of treatment with risankizumab compared with ustekinumab (ultIMMa-1: 54%; ultIMMa-2: 55%).

In addition, 66% and 67% of participants who received risankizumab in ultIMMa-1 and ultIMMa-2, respectively, reported DLQI of 0 or 1 at week 16 compared with those who received ustekinumab (43% and 47%, respectively). At 52 weeks, 75% and 71% of participants who received risankizumab in ultIMMa-1 and ultIMMa-2, respectively, reported DLQI of 0 or 1 compared with 47% and 44% among those who received ustekinumab in ultIMMa-1 and ultIMMa-2, respectively.

The most frequently reported treatment-emergent adverse event in both trials was upper respiratory tract infection among participants who received risankizumab, with 1 participant presenting with latent tuberculosis. 

Reference

Gordon KB, et al. Efficacy and safety of risankizumab: results from two double-blind, placebo-and ustekinumab-controlled, phase 3 trials in moderate-to-severe plaque psoriasis. Presented at: 2018 American Academy of Dermatology Annual Meeting; February 16-20, 2018; San Diego, CA. Abstract 6945.

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