Treating Early for the Long Game: Optimizing IL-17 Inhibitors in Psoriatic Disease

Discuss emerging data for interleukin (IL)-17 agents for psoriatic disease 

Identify strategies to optimize patient outcomes using IL-17 agents earlier in psoriatic disease management

WCM25: Treating Early for the Long Game: Optimizing IL-17 Inhibitors in Psoriatic Disease An Online CME Activity

IL Inhibitors

Tips in the Use of IL-17 Inhibitors in Dermatology

You. Hi, I'm Joe Morola. I'm delighted to be here at fall clinical 2023. I was asked to help cover IL 17 tips and tricks, kind of from my rheumatology perspective. So I'm a dermatologist and rheumatologist, currently the, as of this week, in fact, chair and professor at UT Southwestern in Texas. So I really was focused on how IL 17 is in two words. First line, when it comes to psoriatic arthritis. For many years, the rheumatology community has really thought about tnf inhibition as the go to primary gold standard for psoriatic arthritis. And I think with the head to head data that we have, as well as the benefits over tnf inhibition in skin clearance, IL 17 is clearly at the forefront of our treatment for psoriatic arthritis. We also covered a couple of other tips and tricks that IL 17 inhibitors stand apart from many other mechanisms in being able to treat axial spine disease and psoriatic arthritis, and also being able to inhibit radiographic progression, meaning, we know that we're protecting patients joints when they're taking IL 17 inhibitors. We covered some new data, including from bimikizumab, an IL 17 AF inhibitor that is just approved in the US for psoriasis and outside the US for psoriatic arthritis. So that's quite exciting for us. And we covered, of course, the wonderful skin efficacy done by my colleague here, Bruce Strober, for psoriasis and then for hydrodinitis. It's been a really fantastic meeting and just delighted to be able to share a little bit about psoriatic arthritis. IL 17 tips and tricks my name is Bruce Strober. I'm a clinical professor of dermatology at Yale University. I practice at Central Connecticut Dermatology in Connecticut. In my presentation, I discuss the various uses of IL 17 inhibitors for the treatment of not only psoriatic disease, but also hydratinitis suprativa. We have learned that IL 17 inhibitors basically run the gamut of efficacy across many domains and subtypes of psoriasis. It's basically the issue, if you have psoriasis, you're going to get a deep, rapid, and long lasting response from IL 17 inhibition, and you're also going to cover the psoriatic arthritis component. Now, with regard to hydratinisa Peritiva, we don't yet have an approved IL 17 inhibitor yet on the market, but we will in the near future. And the important point is, IL 17 inhibition treats hs, but depending on the medication you use, you might get better efficacy. For example, I think blocking. Both IL 17 A and F will provide better efficacy than blocking a alone, and there are two drugs in the pipeline, bimikizumab and sonolocumab, that demonstrate this increased efficacy. So look for them in the near future and actually perhaps at higher doses than we typically use for patients with psoriasis. The future of HS therapy is going to be made much brighter because of the presence of IL 17 inhibition and.

Interleukin-17 inhibitors have become widely used in dermatology since secukinumab’s approval for psoriasis in 2015. In this session, Joseph F. Merola, MD, MMSc, and Bruce E. Strober, MD, PhD, discussed the role of IL-17 inhibitors for the management of chronic inflammatory dermatoses. Beginning with psoriasis, Dr Strober reviewed the central role IL-17 plays in psoriasis pathogenesis before diving into the IL-17 inhibitors currently on the market.&nbsp;Secukinumab and ixekizumab are both IL-17-A inhibitors approved for psoriasis in patients 6 years and older. In Phase 3 clinical trials, secukinumab 300 mg Q4W led to 76% to 86% of patients achieving PASI-75 at Week 12. Secukinumab also has shown efficacy for palmoplantar and nail psoriasis. Ixekizumab 80 mg Q2W led to 87% of patients achieving PASI-75 after 12 weeks of treatment in Phase 3 clinical trials. Ixekizumab also demonstrated good efficacy for treatment of genital and nail psoriasis in clinical trials. Brodalumab is an IL-17 receptor inhibitor approved for psoriasis in patients 18 years and older who have failed other systemic therapies. In Phase 3 clinical trials, brodalumab 210 mg Q2W led to 41.6% of patients achieving PASI-100 at Week 12. Due to rare and most likely unrelated completed suicides in clinical trials, brodalumab is only available through a REMS program. All of the currently approved IL-17 inhibitors have low rates of mild mucosal candidiasis and a risk of inflammatory bowel disease (IBD) flare in those with preexisting IBD.&nbsp;Bimekizumab is an IL-17A/F inhibitor currently under investigation for psoriasis. In clinical trials, it has shown the highest level of efficacy for psoriasis to date, with 90.8% of patients achieving PASI-90 at Week 16 and close to 78% of patients maintaining PASI-100 at Week 52. Bimekizumab was found to have higher rates of mucosal candidiasis (up to 15% of treated patients) than other IL-17 inhibitors in clinical trials.&nbsp;Drs Merola and Strober also discussed how secukinumab, ixekizumab, and bimekizumab all have excellent efficacy in psoriatic arthritis (PsA), including in axial disease. Secukinumab has similar ACR20 and ACR50 rates as adalimumab, while bimekizumab has shown the highest efficacy for PsA in clinical trials, with 43.4% of patients achieving ACR50 at Week 16. Drs Merola and Strober also discussed the use of IL-17 inhibitors for hidradenitis suppurativa (HS). Both secukinumab and bimekizumab met their primary endpoints in Phase 3 clinical trials. Secukinumab 300 mg Q4W led to 42% to 46% of patients achieving HiSCR-50 at Week 16, while bimekizumab 320 mg Q4W led to approximately 40% of patients achieving HiSCR-75 at Week 16. Safety profiles of both medications in the HS population appear to be similar to that of the psoriasis population.

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