Patients with psoriasis may achieve better outcomes with secukinumab compared to ustekinumab, according to a study.
The study observed that, for both medications, effectiveness was lower in a real-world clinical setting than in a trial setting. Overall, though, secukinumab was more effective than ustekinumab.
The researchers collected data from the British Association of Dermatologists Biologics and Immunomodulators Register, which includes patients with moderate to serve psoriasis in the United Kingdom and Republic of Ireland. The present analysis consisted of patients with chronic plaque psoriasis who were aged 18 or older and had at least 1 record of a Psoriasis Area and Severity Index (PASI) of 12 or higher prior to initiating either medication.
In addition to comparing secukinumab and ustekinumab, the study authors also tested if they could replicate the relative effectiveness estimate of the CLEAR trial, a randomized clinical trial comparing secukinumab versus ustekinumab in psoriasis.
The main outcomes were the risk ratio (RR) and risk difference (RD) of achieving PASI of 2 or lower after one year of either secukinumab or ustekinumab. The effect estimates for the current study were benchmarked against those observed in the CLEAR trial.
Final analysis included 1,231 patients: 917 in the ustekinumab group and 314 in the secukinumab group. In almost all analyses, secukinumab outperformed ustekinumab. The only exception was under the nonresponder imputation method when analyzing the proportion of patients who attained a PASI of 2 or lower: RR, 1.28 (95% confidence interval [CI], 1.06-1.55) and RD, 11.9% (95% CI, 1.6-22.1%).
The study was published in JAMA Dermatology.
“This comparative effectiveness study found that secukinumab resulted in more patients achieving a PASI of 2 or lower after 12 months of therapy compared with ustekinumab in patients with psoriasis. Target trial emulation in this study resulted in regulatory and estimate agreement with the CLEAR randomized clinical trial; further such studies may help fill the evidence gap when comparing other systemic therapies for psoriasis,” the researchers concluded.