Ixekizumab versus Guselkumab in Plaque Psoriasis

Achieving skin clearance in a timely manner is important for patients with moderate-to-severe plaque psoriasis. Previous studies have not compared early responses between interleukin (IL)-17 versus IL-23 inhibitors in this patient population. A randomized, double-blinded trial compared early responses associated with IL-17A inhibitor ixekizumab versus IL-23p19 inhibitor guselkumab in patients with moderate-to-severe plaque psoriasis.

IXORA-R was a 24-week trial that included adult patients with plaque psoriasis who had a static Physician’s Global Assessment of Disease (sPGA) score of ≥3, Psoriasis Area and Severity Index (PASI) of ≥12, and ≥10% body surface area. A total of 1,027 patients were randomized 1:1 to the approved dose of either subcutaneous ixekizumab or guselkumab. The main outcome measure was 12-week 100% improvement in PASI (PASI 100); additional outcomes included improvements in PASI and sPGA at different timepoints. The researchers used the Cochran-Mantel-Haenszel test with a multiple testing strategy to compare outcomes.

At 12 weeks, a higher proportion of patients in the ixekizumab group than the guselkumab group reached the primary endpoint of PASI 100 (n=215/520 [41%] vs. n=126/507 [25%], respectively; P<0.001). Secondary endpoints, including one-week PASI 50 and two-week PASI 75, were all met. Both groups had a 3% rate of serious adverse events (AEs). The study did not present any new safety signals.

The authors concluded that ixekizumab was superior to guselkumab in terms of rapid improvement in psoriasis signs and symptoms, with no significant differences in AE rate. The study’s final endpoint, 24-week PASI 100, as well as 24-week safety data will be reported at a later time.