INTRODUCTION & OBJECTIVES: Secukinumab, a fully human monoclonal antibody (mAb) that selectively targets IL-17A, is highly efficacious in the treatment of moderate to severe plaque psoriasis, starting at early time points, with a sustained effect and a favorable safety profile. We explored the relationship between skin-related quality of life as measured by the Dermatology Life Quality Index (DLQI) and skin clearance as measured by the Psoriasis Area and Severity Index (PASI).
MATERIALS & METHODS: The CLEAR study was a phase 3b study that compared secukinumab and ustekinumab in adults with moderate to severe plaque psoriasis. Data to week 16 data were included. The DLQI total, subscale (Symptoms and Feelings, Daily Activities, Leisure, Work/School, Personal Relationships, and Treatment), and item-level scores, and the PASI were evaluated at baseline and Weeks 4, 8, 12, and 16 for secukinumab 300 mg. DLQI response was defined as no effect of skin problems on health-related quality-of-life (total score 0 or 1; 0 for subscale and item score). PASI response level was categorized as 75-89 and 90-100. The effect of skin clearance levels on DLQI scores was evaluated (using ANCOVA and Pearson Chi-square test statistics) for secukinumab 300 mg.
RESULTS: DLQI data were analyzed for 310 patients (PASI 90-100/PASI 75-89: n=264/46). Generally, improvements in DLQI scores from baseline to Week 16 were higher as PASI skin clearance level increased (PASI90-100/PASI75-89) DLQI mean (SD) improvement: Total=12.3(7.3)/10.0(8.4), Symptoms and Feelings=3.4(1.7)/2.5(1.6), Daily Activities=2.8(1.9)/2.3(2.0) Leisure=2.2(2.1)/2.0(2.4),Work/School=0.8(1.1)/0.6(1.1), Personal Relationships=1.7(1.8)/1.3(2.2), and Treatment=1.2(1.1)/1.1(1.1)). A significantly higher percentage of patients achieving PASI 90-100 were DLQI responders for Total Score (78% vs. 57%), Symptoms and Feelings (59% vs. 27%), Daily Activities (89% vs. 68%), Personal Relationships (90% vs. 76%) and Treatment (95% vs. 73%) subscales at Week 16 than those achieving PASI 75-89 (all P< 0.05). Similar trends were observed for DLQI item-level evaluations.
CONCLISIONS: In patients treated with secukinumab 300 mg, higher levels of skin clearance translated into greater patient-reported benefits.
