The Role of Ixekizumab in Palmoplantar Psoriasis | Insights from AAD 2023
Palmoplanter psoriasis occurs in 12–16% of patients with psoriasis in the USA.1 These patients report greater health-related quality of life impairments than patients with other forms of psoriasis.1 Ixekizumab (Eli Lilly and Company, Indianapolis, IN, USA) is an interleukin-17 antagonist that has been approved for use in moderate-to-severe plaque psoriasis and psoriatic arthritis.2
A poster summarizing the clearance of palms and soles with label-dose ixekizumab for up to 5 years in patients with moderate-to-severe plaque psoriasis in a post hoc analysis of previously published data from six phase III clinical trials was presented at the 2023 American Academy of Dermatology Annual Meeting (New Orleans, LA, USA).3 This post hoc analysis included pooled data of 57 patients from integrated UNCOVER-1 (ClinicalTrials.gov identifier: NCT01474512) and UNCOVER-2 (ClinicalTrials.gov identifier: NCT01597245), 96 patients from UNCOVER-3 (ClinicalTrials.gov identifier: NCT01646177), 51 Chinese patients from I1F-MC-RHBH(ClinicalTrials.gov identifier: NCT03364309), 37 patients from IXORA-S (ClinicalTrials.gov identifier: NCT02561806) and 15 patients from IXORA-PEDS (ClinicalTrials.gov identifier: NCT03073200).3 Dr Alan Menter provided his insights on this analysis.
The endpoint of complete clearance of palmoplantar psoriasis was assessed by a 100% reduction in the Palmoplantar Psoriasis Area and Severity Index (PPASI 100).3 PPASI 100 was assessed across all trials at shared time points, from week 4 to 1 year (I1F-MC-RHBH, IXORA-S), 2 years (IXORA-PEDS) and 5 years (UNCOVER-1 and UNCOVER-2 and UNCOVER-3).3 These endpoints were designed to assess patient quality of life. Dr Menter said, “Quality of life, I think, is the most important inclusion criteria for the post hoc analysis. In other words, how long after the treatment has been discontinued and the patient is clear? How long will the patient’s palmoplantar psoriasis stay clear without recurring?”.
Dr Menter continued, “I think in the majority of cases there was both rapid response and sustained response”. The observed PPASI 100 response rate at 4 weeks for adult patients ranged from 38.9% (95% confidence interval [CI] 29.1–48.8 [UNCOVER-3]) to 52.9% (95% CI 39.2–66.6 [I1F-MC-RHBH]).3 At 1 year, the PPASI 100 response rate had increased and ranged from 83.5% (95% CI 75.6–91.4 [UNCOVER-3]) to 96.0% (95% CI 88.3–100.0 [I1F-MC-RHBH]).3 At 5 years, this response rate increased further to 96.6% (95% CI 89.9–100.0) in UNCOVER-1 and UNCOVER-2 and to 90.2% (95% CI: 81.2–99.3) UNCOVER-3.3 In paediatric patients, the PPASI 100 response rate at 4 weeks was 21.4% (95% CI 0.0–42.9); at 108 weeks, this had increased to 90.0% (95% CI 71.4–100.0).3
Commenting on the potential for these results to influence clinical practice, Dr Menter said, “I think it’s one of the major therapies for palmoplantar psoriasis in clinical practice […]. I do believe that for palmoplantar psoriasis that we’re discussing, that ixekizumab has done an extremely good job as monotherapy or in combination with systemic drugs”.
The full video interview with Dr Menter is available on touchIMMUNOLOGT here.
The abstract discussed in this interview is the following:
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- Merola JF, Li T, Li, W-Q, et al. Prevalence of psoriasis phenotypes among men and women in the USA. Clin Exp Dermatol. 2016;41:486–9.
- Craig S, Warren RB. Ixekizumab for the treatment of psoriasis: Up-to-date. Expert Opin Biol Ther. 2020;20:549–57.
- Menter MA, Armstrong A, Kircik L, et al. Palmoplantar psoriasis complete clearance is achieved rapidly and sustained with ixekizumab treatment in adult and pediatric patients with moderate-to-severe plaque psoriasis. Presented at American Academy of Dermatology (ADD) 2023, New Orleans, LA, USA, 17–21 March 2023. Abstr 41824.
