Palmoplantar pustular psoriasis: secukinumab fails 2PRECISE trial

  • Mrowietz U & al.
  • J Am Acad Dermatol
  • 1 Feb 2019

  • curated by Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • In the phase 3b 2PRECISE randomized controlled trial, secukinumab (Cosentyx) was associated with clinical response and improved QoL, but did not meet the primary endpoint in patients with moderate to severe palmoplantar pustular psoriasis (PPP).

Why this matters

  • PPP is resistant to treatment and associated with high recurrence rates.

Key results

  • Secukinumab 300 mg was associated with a higher rate of >75% improvement in palmoplantar psoriasis area and severity index (ppPASI 75) at week 16 compared with placebo (26.6% vs 14.1%; OR, 2.62; P=.0411).
    • This result did not achieve the primary objective for significance (smaller of the 2 obtained P values from the logistic regression model ≤2.5%).
    • 41.8% of patients treated with secukinumab 300 mg achieved ppPASI 75 at week 52.
  • Secukinumab 300 mg was associated with a higher rate of DLQI 0/1 response at week 16 compared with placebo (13.0% vs 4.3%).
  • The most frequent adverse events were nasopharyngitis, pustular psoriasis, headache, and pruritus (incidence rate per 100 patient-years 50.3, 30.5, 16.1, and 15.1, respectively, for secukinumab 300 mg).

Study design

  • 237 patients with moderate to severe PPP, 79 treated with secukinumab 300 mg, 80 with secukinumab 150 mg, and 78 with placebo, were included.
  • Funding: Novartis.

Limitations

  • Relatively small sample size.

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