Abatacept treatment does not prevent relapse of psoriasis following withdrawal of ustekinumab, according to a study published online Oct. 13 in JAMA Dermatology.

Kristina M. Harris, Ph.D., from the University of California in San Francisco, and colleagues examined whether costimulatory signaling blockade with abatacept prevents psoriasis relapse after withdrawal of ustekinumab. Adults with moderate-to-severe plaque psoriasis were enrolled and received ustekinumab in a lead-in phase. Those who responded at week 12 (91 patients) were randomly assigned to continue with ustekinumab or were switched to abatacept. Treatment was discontinued at week 39, and follow-up continued until week 88.

The researchers found that similar proportions of patients in the abatacept and ustekinumab groups relapsed between weeks 12 and 88 (91.1 versus 87.0 percent; P = 0.41). From the last dose of ustekinumab, the median time to relapse was similar between the groups: 36 versus 32 weeks, respectively. The numbers and rates of adverse events were similar between the groups. Suppression of the pathogenic interleukin (IL)-23-mediated psoriasis molecular signature in lesions was not maintained by abatacept after ustekinumab withdrawal; in addition, serum IL-19 levels increased.

"Although abatacept is approved for psoriatic arthritis, the results of this trial do not support abatacept as a choice for treating psoriatic arthritis and psoriasis skin lesions concurrently," the authors write.

Several authors disclosed ties to the pharmaceutical industry; Bristol Myers Squibb, Meso Scale Diagnostics LLC, and Eli Lilly and Co. provided funding/support; Rho Inc. also provided support in the analysis of data.

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