Cumulative benefit of brodalumab in plaque PsO: A retrospective, real-world study

Results from a multicenter, retrospective, observational, real-world, Italian Landscape Psoriasis (IL PsO) database study evaluating the patient-level cumulative clinical benefit of brodalumab in adults with moderate-to-severe plaque psoriasis (PsO) who were treated in routine clinical practice were published in Dermatology and Therapy by Potestio et al. The primary outcome was the normalized cumulative clinical benefit achieved over 52 weeks, calculated from the area under the curve (AUC) of individual longitudinal percentage Psoriasis Area and Severity Index (PASI) improvement. The primary analysis included patients with PASI assessments at baseline and Weeks 16, 32, and 52 (n = 764). 

Key data: Median PASI decreased from 14.7 at baseline to 0.0 at Weeks 16, 32, and 52 (p < 0.001). At Week 52, PASI75, PASI90, and PASI100 were attained by 93.1%, 86.1%, and 70.4% of patients, respectively. Median normalized cumulative clinical benefit was 97.4%, corresponding to a median clearance-equivalent time of 300 days. Overall, 50.3% of patients accumulated 300–308 clearance-equivalent days and 38.5% accumulated 250 to <300 days. In a multivariable analysis (n = 645), palmoplantar involvement was independently associated with lower cumulative benefit (adjusted median difference, −3.21; 95% confidence interval [CI], −6.29 to −0.87; bootstrap p = 0.010), whereas scalp/facial involvement was associated with greater benefit (+1.39; 95% CI, 0.38–3.27; bootstrap p = 0.010). 

Key learning: In this retrospective study, brodalumab provided rapid, deep, and sustained disease control over 52 weeks in routine clinical practice, supporting the use of patient-level cumulative AUC-based outcomes as a complement to conventional PASI response rates; however, prospective studies are warranted to validate their clinical relevance.