Efficacy of Brodalumab and Guselkumab in Patients with Moderate-to-Severe Plaque Psoriasis Who are Inadequate Responders to Ustekinumab: A Matching Adjusted Indirect Comparison

Figures & data

Figure 1 Trial designs of NAVIGATE and AMAGINE 2/3. In AMAGINE-2 and −3, at week 12, patients who were originally randomized to brodalumab underwent repeat randomization (2:2:2:1) to one of four maintenance regimens: brodalumab at 210 mg every 2 weeks, 140 mg every 2 weeks, 140 mg every 4 weeks, or 140 mg every 8 weeks. Patients who were originally randomized to placebo were switched to brodalumab at a dose of 210 mg every 2 weeks. Patients who were originally randomly assigned to receive ustekinumab and had an adequate response continued to receive ustekinumab every 12 weeks until week 52. These details are reported in more detail in Lebwohl et al 2015.

Abbreviations: IGA, investigator’s global assessment; sPGA, static physician’s global assessment.

Table 1 Baseline Characteristics of Patients

	Brodalumab Before Reweighting (n=121)	Brodalumab After Reweighting (n=90)	Guselkumab (n=135)
Age (years), mean	47.1	44.2	44.2
Gender, male, %	71.7	70.4	70.4
BMI, mean, kg/m^2	32.2	30.3	30.3
Psoriatic arthritis, %	27.5	20.7	20.7
Duration of disease (years), mean	18.0	18.2	18.2
Prior topical psoriasis treatment, %	87.5	94.8	94.8
Prior phototherapy, %	48.3	51.9	51.9
Prior systemic psoriasis treatment, %	44.2	59.3	59.3
Prior anti-TNF, %	30.8	23.7	23.7
PASI week 16	11.1	9.8	9.8
DLQI week 16	8.5	7.5	7.5

Abbreviations: BMI, body mass index; DLQI, Dermatology Life Quality Index; PASI, psoriasis area and severity index; TNF, tumor necrosis factor.

Table 2 PASI 90, PASI 100, PGA and DLQI Rates with Brodalumab and Guselkumab After Switching from Ustekinumab

Endpoint	Weeks After Switch	Brodalumab, Before Reweighting	Brodalumab, After Reweighting	Guselkumab	Unanchored Risk Difference (Bro-Gus)	P-value	Effective Sample Size	NNT
PASI 90	12	57.9% (48.1–67.6%)	62.7% (58.8–66.7%)	48.1% (39.7–56.6%)	14.6% (5.3–23.9%)	0.002	90.2	6.8
	36	58.7% (57.1–60.2%)	63.7% (63.2–64.2%)	51.1% (42.7–59.5%)	12.6% (4.1–21.0%)	0.004	90.2	7.9
PASI 100	36	37.2% (37.0–37.4%)	40.3% (35.2–45.3%)	20.0% (13.3–26.7%)	20.3% (11.8–28.7%)	<0.001	90.2	4.9
PGA success	12	50.0% (48.8–51.2%)	50.2% (42.8–57.6%)	31.1% (23.3–38.9%)	19.1% (8.3–29.9%)	<0.001	89.2	5.2
	36	50.0% (46.5–53.5%)	50.0% (40.3–59.7%)	36.3% (28.2–44.4%)	13.7% (1.1–26.4%)	0.033	89.2	7.3
DLQI 0/1	36	45.1% (40.4–49.8%)	52.5% (43.8–61.2%)	38.8% (29.4–48.2%)	13.7% (0.8–26.5%)	0.037	74.8	7.3

Note: NNT is based on difference in responder rates between brodalumab and guselkumab (ie represents the average number of patients needed to be treated with brodalumab for one more patient to achieve the efficacy measure compared with guselkumab.

Abbreviations: DLQI, Dermatology Life Quality Index; PGA, physician’s global assessment; NNT, number needed to treat; PASI, psoriasis area and severity index.

Figure 2 Forest plot of PASI 90, PASI 100, PGA success and DLQI 0/1 rates at 12 and 36 weeks after switching from ustekinumab.

Abbreviations: CI, confidence interval; DLQI, Dermatology Life Quality Index; PASI, psoriasis area and severity index; PGA, physician’s global assessment.

Table 3 PASI 90, PASI 100, and PGA Rates According to PGA Score at Time of Switching from Ustekinumab to Brodalumab

PGA at Treatment Switch	PASI 90 Week 36	PASI 100 Week 36	PGA Success Week 12	PGA Success Week 36
2 (n=53)	41 (77.4%)	27 (50.9%)	27 (50.9%)	27 (50.9%)
3 (n=49)	24 (49.0%)	16 (32.7%)	28 (57.1)	27 (55.1%)
4/5 (n=18)	6 (33.3%)	2 (11.1%)	5 (27.8%)	6 (33.3%)

Abbreviations: PGA, physician’s global assessment; PASI, psoriasis area and severity index.