Secukinumab for psoriasis: don't skip the weekly loading doses

  • Gisondi P & al.
  • Br J Dermatol
  • 20 Apr 2019

  • International Clinical Digest
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Takeaway

  • In patients with psoriasis, the administration of secukinumab (Cosentyx) without the labeled loading dose is associated with lower initial efficacy that appears to recover after 12 weeks.

Why this matters

  • Secukinumab should be administered at the labeled 300-mg dose at weeks 0, 1, 2, 3, and 4 (loading dose), and every 4 weeks thereafter.

Key results

  • Patients who did not receive the loading dose had lower ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) and PASI 90 at 8 weeks (40.20% vs 60.01% and 30.50% vs 45.10%, respectively) and 12 weeks (60.61% vs 72.22% and 40.30% vs 49.37%, respectively) compared with patients who received the loading dose (P<.01 for all>
  • Efficacy rates were similar at 16, 32, and 48 weeks (P>.05):
    • PASI 75: 74.68% vs 77.35%, 77.19% vs 85.14%, and 77.59% vs 78.57% for no loading dose vs loading dose.
    • PASI 90: 46.67% vs 54.44%, 47.37% vs 54.65%, and 54.29% vs 56.9% for no loading dose vs loading dose.
  • Patients who did not receive the loading dose were more likely to discontinue for inefficacy (24.6% vs 13.3%; P<.05>

Study design

  • 156 patients with psoriasis; 75 received the labeled loading dose and 81 did not.
  • Funding: None.

Limitations

  • Retrospective study.