Outcomes With Treatment and Withdraw of Secukinumab in Patients With Plaque Psoriasis
Status:
Not yet recruiting
Trial end date:
2026-12-01
Target enrollment:
Participant gender:
Summary
Psoriasis (PsO) is a systemic immune disease that affect 2-4% of the population worldwide.
PsO causes tremendous burden in terms of quality of life, psychological impact, disability
and work productivity of affected individuals. PsO is associated with an increased risk of
cardiovascular morbidities and mortality in the long term. Up to 30% of PsO patients develop
psoriatic arthritis (PsA) over time causing joint deformities and further disabilities.
Majority of patients with PsA developed PsO first, and arthritis develop 5-10 years after.
PsA and PsO are increasingly recognized as two entities under the umbrella of psoriatic
diseases.
Advances in biological treatments have greatly improved the prognosis of patients with PsO.
Remarkable efficacies have been demonstrated for patients with moderate to severe PsO in
randomized controlled trials (RCTs). However, the high cost of biological treatment is one of
the major barriers to its prescription and many patients may have limited access to these
treatments.
The best treatment strategy for PsO that takes into account efficacy and cost effectiveness
is unknown. For instance, whether some PsO patients can stop biological treatment and be
treated with non-biologic medications upon relapse, which may enhance cost effectiveness of
treatment. Preliminary studies have shown that some PsO patients were able to maintain good
control of disease without medications after biologics withdrawal. The patho-immunological
mechanisms behind long term remission after drug withdrawal is poorly understood. Better
understanding of these mechanisms in maintaining remission and relapses will advance the
development of biomarkers that eventually guide development of best treatment strategies for
PsO.
Secukinumab targets interleukin (IL)-17a and is highly efficacious in the treatment of plague
PsO with a favorable safety profile. Some patients may have the response maintained after
withdrawal of secukinumab. With the proven efficacies, sustainability after withdrawal and
safety profile, secukinumab could be a choice of initial treatment for patients with moderate
to severe PsO. Secukinumab has been recommended as first line treatment for selected patients
with moderate to severe PsO by the American Academy of Dermatology and the European S3
guidelines. However, the use of biologics as first line is limited by cost issue. Overall,
real-life data on biologic treatment for moderate to severe PsO is scanty.