Tips in the Use of IL-17 Inhibitors in Dermatology
Professor and Chair
University of Texas Southwestern Medical Center
Clinical Professor of Dermatology
Yale University School of Medicine
New Haven, CT
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.
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.
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.
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.