Scalp psoriasis can be a particularly challenging manifestation for many patients. So recently, a post-hoc analysis of data looking at ixekizumab for moderate to severe plaque psoriasis in adult patients with five years of treatment was conducted. Read more on the details of the study and what this means for psoriasis patients.
Post-Hoc Analysis of Scalp Psoriasis Treatment After Five Years
Psoriasis reported affecting over 55 million adults globally, and for many patients, this involves psoriasis on the scalp. Scalp psoriasis can be a particularly challenging manifestation for many patients, affecting not only physically but psychologically and socially. However, a recent publication reported on the long-term effects of ixekizumab on clinical and patient outcomes after five years.
Study Design
The researchers conducted a post-hoc analysis of data from the UNCOVER-1, -2, and -3, randomized controlled trials, which evaluated the efficacy of ixekizumab for moderate to severe, chronic plaque psoriasis in adult patients with five years of treatment. More specifically, it involved patients who were over the age of 18, who were diagnosed with chronic plaque psoriasis greater than six months before enrollment, who were eligible for phototherapy and/or systemic treatment with no previous treatment of etanercept, with greater than or equal to 10 percent body surface area involvement and a Psoriasis Scalp Severity Index score greater than 12 at baseline and PSSI – 0 at the end of five years.
Clinical and Patient Endpoints
The study assessed treatment efficacy through clinical outcomes, namely a Psoriasis Area and Severity Index (PASI) score to quantify the severity and extent of psoriasis. Additionally, patient reported outcomes were evaluated through questionnaires with three focus domains, itch, scaling, pain, and overall quality of life, specifically, the Itch Numeric Rating Scale (NRS), Skin Pain Visual Analogue Scale (VAS), and the Dermatology Life Quality Index (DLQI), respectively.
Findings for Scalp Psoriasis Management
There were 538 patients who were eligible for this study, 189 from the UNCOVER-1 and -2 studies, and 349 from the UNCOVER-3 study. Baseline patient demographic characteristics were similar across the studies, with an average age of 45 years of age, approximately 66.5 percent were male, with a collective BMI of 30.2 kilograms per meter squared, and a mean duration of psoriasis symptoms of 17.6 years.
Over the course of receiving five years of treatment, starting with a PSSI score of 20.0, researchers reported steady decreases of PSSI scores as early as two weeks into the study, with at least 84.9 percent of patients. Achieving complete resolution of scalp psoriasis at five years.
For patient reported outcomes, improved quality of life was reported for all domains from baseline as early as twelve weeks as assessed by the DLQI. Similarly, improvements were reported for decreased itching and pain on average in 82.6-88.4 percent and 84.4 percent of patients. The long-term effects of ixekizumab showed continued improvements through five years in DLQI total score of 94.3 percent, Itch NRS score between 86.4 and 90.8 percent, and the Skin Pain VAS score being 95.2 percent. In the same patient population those who achieved a PSSI-0 score, between 58.5 to 73.2 percent, also experienced complete skin clearance through five years. Despite the inability to conduct a pooled analysis, the effectiveness of ixekizumab on treating moderative to sever psoriasis with scalp involvement appears encouraging.
Conclusions
As treatment landscape continues to change, this post-hoc analysis adds to the growing body of evidence supporting the use of ixekizumab in achieving and maintaining long-term control of scalp psoriasis. More specifically, patients reported not only improvement, but also achievement and maintenance of complete clearance of skin and scalp, decreases in itching and pain, and improvements to overall quality of life and improve the psychosocial well-being of patients.
References
Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008;159(5):997-1035. doi:10.1111/j.1365-2133.2008.08832.x
Egeberg A, Hawkes JE, Somani N, et al. Sustained Improvements in Clinical and Patient-Reported Outcomes and Quality of Life Through 5 Years Among Ixekizumab-Treated Patients with Complete Clearance of Scalp Psoriasis by Week 60. Dermatol Ther (Heidelb). 2024;14(4):1007-1018. doi:10.1007/s13555-024-01147-7
Gordon KB, Colombel JF, Hardin DS. Phase 3 Trials of Ixekizumab in Moderate-to-Severe Plaque Psoriasis. N Engl J Med. 2016;375(21):2102. doi:10.1056/NEJMc1610828
Griffiths CE, Reich K, Lebwohl M, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet. 2015;386(9993):541-551. doi:10.1016/S0140-6736(15)60125-8
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