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2024-05-23T15:19:14.000Z

Ixekizumab: 5-year sustainability of scalp psoriasis clearance and patient-reported outcomes

May 23, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in psoriasis.

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Scalp involvement occurs in approximately 50-80% of individuals with psoriasis and can be difficult-to-treat with conventional non-systemic therapies.1 Scalp psoriasis affects patients socially and psychologically, and increases disease and itch severity compared with psoriasis in other body areas.1 Therefore, patient-reported outcomes are key in trials investigating scalp psoriasis.

Here, we summarize an analysis by Egeberg et al.1 published in Dermatology and Therapy on clinical and patient-reported outcomes after ixekizumab treatment in patients with scalp psoriasis over a 5-year period.1 Ixekizumab has not been studied specifically in scalp psoriasis, therefore this post hoc analysis focuses on a subset of patients with scalp psoriasis from the phase III UNCOVER-1, -2, and -3 trials.1 

Study design1 

  • UNCOVER-1 (NCT01474512), UNCOVER-2 (NCT01597245), and UNCOVER- 3 (NCT01646177) were double-blind, randomized phase III trials in patients with moderate-to-severe plaque psoriasis.  

  • Psoriasis Scalp Severity Index (PSSI) was assessed from baseline through to 5 years. 

  • Itch Numeric Rating Scale (NRS), Skin Pain Visual Analog Scale, and Dermatology Life Quality Index were used to assess patient-reported outcomes. 

Key findings1 

  • A total of 538 patients with scalp psoriasis who were treated with ixekizumab and had a PSSI measurement at Week 60 were included. 

  • A high proportion of patients achieved a PSSI-0 (complete clearance of scalp psoriasis) at Week 60 (88.4% of patients from UNCOVER-1/2 and 75.9% of patients from UNCOVER-3).  

  • Overall, 84.9% and ≥88.5% of patients maintained a PSSI-0 response at Week 60 through to Week 264 in UNCOVER-1/2 and UNCOVER-3, respectively. 

  • In Week 60 PSSI-0 responders, substantial mean improvements from baseline to Week 12 were observed in all patient-reported outcome measures (Figure 1); these improvements were maintained to Week 264 (improvements of 94.3% in Dermatology Life Quality Index, 90.8% in Itch NRS, and 95.2% in Skin Pain Visual Analog Scale in UNCOVER-1/2).  

Figure 1. Patient-reported outcomes at Week 12 and Week 256 in Week 60 PSSI-0 responders* 

DLQI, Dermatology Life Quality Index; Itch NRS, Itch Numeric Rating Scale; PSSI, Psoriasis Scalp Severity Index; Skin Pain VAS, Skin Pain Visual Analog Scale. 
*Data from Egeberg, et al.1 

  • At Week 60, 70.7% and 73.2% of patients had concurrent PSSI-0 and a 100% improvement in Psoriasis Area and Severity Index in the UNCOVER-1/2 and UNCOVER-3 trials, respectively. This was maintained in the ranges of 70.761.3% and 73.258.5% to Week 264 in the UNCOVER-1/2 and UNCOVER-3 trials, respectively. 

Key learnings  

  • In this post hoc analysis, the majority of patients with scalp psoriasis who were treated with ixekizumab experienced complete scalp clearance at Week 60, which was sustained through 5 years. 

  • Patients who experienced scalp clearance at Week 60 were likely to experience improvements in quality of life measures, including itch severity, at Week 12 through to 5 years. 

 

  1. Egeberg A, Hawkes JE, Somani N, et al. Sustained improvements in clinical and patient- reported outcomes and quality of life through 5 years among ixekizumab-treated patients with complete clearance of scalp psoriasis by Week 60. Dermatol Ther. 2024;14(4):1007-1018. DOI: 10.1007/s13555-024-01147-7 

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