Brodalumab in the treatment of chronic plaque psoriasis

ABSTRACT

Introduction

A number of highly selective biologic therapies that target specific immunological pathways of psoriasis have emerged, including molecules that target interleukin (IL)-17. IL-17 has been identified as a key effector pathogenic cytokine in psoriasis, and validated as a highly effective therapeutic target for the treatment of plaque psoriasis.

Area covered

This review examines the therapeutic efficacy and safety of IL-17 inhibitors in plaque psoriasis and provides an overview of the efficacy and safety data of brodalumab compared with other IL-17 inhibitors.

Expert opinion

In the real world, the treatment of psoriasis has been revolutionized by the new class of drugs belonging to IL-17 inhibitors, with secukinumab, ixekizumab, and brodalumab currently licensed and approved for the treatment of moderate-to-severe plaque psoriasis. With its distinct mechanism of action, brodalumab may offer a unique advantage over other IL-17 inhibitors due to its rapid onset of action, achievement of complete skin clearance in a high proportion of patients, and its overall favorable safety profile. Importantly, treatment with systemic biologic drugs should be established early on in the course of the disease in order to prevent comorbidities and to allow patients to achieve a stable and persistent remission.

KEYWORDS:

• Brodalumab
• efficacy
• interleukin-17 inhibitors
• plaque psoriasis
• psoriasis Area and Severity Index

Article highlights

• Interleukin (IL)-17 is a key effector pathogenic cytokine in psoriasis and a highly effective therapeutic target for the treatment of plaque psoriasis.

• Three IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) are currently licensed and approved for the treatment of moderate-to-severe plaque psoriasis in the United States of America and in Europe; bimekizumab is in clinical trials.

• Brodalumab specifically targets IL-17RA, a receptor subunit of IL-17A, IL-17C, IL-E, and IL-17F, whereas secukinumab and ixekizumab specifically inhibit IL-17A.

• Brodalumab has a rapid onset of action, improves psoriasis-associated inflammation and clinical symptoms, and is efficacious in difficult-to-treat areas such as the scalp and nails.

• Brodalumab has demonstrated efficacy in psoriasis patients with prior exposure to or who have failed previous biologics, including anti-IL-17A agents.

• Brodalumab has a favorable safety profile and is safe and well tolerated, even over the longer-term, with the most frequent AEs being nasopharyngitis, upper respiratory tract infection, and headache.

• Brodalumab is an important treatment option for patients with moderate-to-severe plaque psoriasis due to its high rates of clinical efficacy, as demonstrated by the high proportion of patients achieving and maintaining PASI 100, and its overall favorable safety profile.

This box summarizes key points contained in the article.

Acknowledgments

Medical writing assistance was provided by Melanie Gatt (PhD), an independent medical writer, on behalf of Springer Healthcare.

Declaration of interest

P Gisondi served as consultant for AbbVie, Abiogen, Almirall, Celgene, Eli-Lilly, Janssen, Leo Pharma, Merck, MSD, Novartis, Otsuka, Pfizer, Pierre Fabre, Sanofi, UCB. G Girolomoni served as consultant for AbbVie, Abiogen, Allmirall, Amgen, Bayer, Biogen, Boehringer Ingelheim, Celgene, Eli-Lilly, Galderma, Leo Pharma, Menlo Therapeutics, Merck, MSD, Novartis, Pfizer, Pierre Fabre, Regeneron, Sandoz, Sanofi, Sun Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One of the reviewers on this manuscript declares to have received research funds from: Abbvie, Boehringer Ingelheim, Celgene, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Leo Pharmaceuticals, Medimmune/Astra Zeneca, Novartis, Pfizer, Sciderm, Valeant, and ViDac. They are also a consultant for Allergan, Aqua, Boehringer-Ingelheim, LEO Pharma, Menlo, Mitsubishi, Promius and Theravance. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Medical writing assistance was used for the preparation of this manuscript, funded by LEO Pharma.