A study of the biologic drug ustekinumab has found it to be a better treatment for psoriasis than tumor necrosis factor-alpha (TNF-α) inhibitors.
The PSOLAR (Psoriasis Longitudinal Assessment and Registry) study is an ongoing prospective study following patients receiving or eligible to receive systemic or biologic therapies. An early analysis of the data, published in the Journal of the American Academy of Dermatology, compared the effectiveness of three TNF-α inhibitors (infliximab, adalimumab, and etanercept) with ustekinumab, which works by targeting the cytokines interleukin-12 and interkeukin-23. The drugs were evaluated based on the standard clinical and health related quality of life (HRQoL) measures of Physician Global Assessment (PGA), percentage of body surface area with psoriasis (%BSA), and Dermatology Life Quality Index (DLQI) after 6 months and 12 months of treatment.
The study population included 2076 patients with psoriasis who were treated with ustekinumab (1041 patients), infliximab (116 patients), adalimumab (662 patients), or etanercept (257 patients). The mean age of all participants was 46.5 years, and the distribution of males and females was nearly even. Mean disease duration was 17.5 years.
At 6-month and 12-month follow-ups, respective proportions of patients receiving a PGA score of 0 or 1 (low severity of skin lesions) were 57.1% and 59.2% for ustekinumab, 50.1% and 56.5% for adalimumab, 50.6% and 57.6% for etanercept, and 36.4% and 42.0% for infliximab. Adjusted analysis confirmed that treatment with any TNF-α inhibitor was less likely to result in a PGA score of 0 or 1 compared with ustekinumab treatment.
Overall, %BSA also declined most significantly in patients receiving ustekinumab, and HRQoL scores were the highest in this group. Additionally, after 6 months, the percentage of patients taking ustekinumab that experienced a clinically meaningful event after scoring below a 10 in the DLQI was 54.7%, higher than for any other treatment group.
Bruce E Strober, MD, PhD, University of Connecticut Health Center, Farmington, CT, and his coauthors concluded that the performance of ustekinumab exceeded those of all TNF-α inhibitors on nearly every measure at both follow-up times. The researchers caution, however, that the current study results are limited by selection bias and a lack of data regarding dosing intervals. Additionally data from the study will be needed in order to confirm the results.
