Secukinumab 2‐weekly vs. 4‐weekly dosing in plaque‐type psoriasis

Linked Article:   Reich et al. Br J Dermatol 2021; 184 :849–856. Psoriasis is a disease that causes scaly patches of skin that can cover large areas of the body including the scalp, hands and feet, and people’s nails can be affected too. It can greatly reduce quality of life for those that are affected. Secukinumab is a licensed treatment for psoriasis involving injections just under the skin. In clinical practice, doctors may adjust the amount of secukinumab prescribed (dose) depending on how well patients respond to treatment in the first 16 weeks. However, more scientific evidence (from controlled clinical studies) is needed to improve these treatment decisions. Secukinumab is initially prescribed as one dose (300 mg) per week for the first 4 weeks. After this, the frequency is reduced to one dose every 4 weeks. After 16 weeks of treatment, most patients achieve a 90% reduction of their psoriasis skin symptoms. However, some patients only achieve a 75% reduction at this stage. For these patients, the GAIN study tested whether one dose every 2 weeks would be beneficial compared with the standard one dose every 4 weeks. The GAIN study showed a potential benefit of secukinumab dosing every 2 weeks in some patients who did not respond as well as hoped to secukinumab treatment every 4 weeks. Although there was no statistically significant difference in the percentage of patients who achieved a 90% reduction of psoriasis skin symptoms in each group, significantly more patients achieved clear or almost clear skin and a complete normalization of their quality of life with more frequent dosing. Continued treatment with the approved one dose every 4 weeks also had an improved response after 16 weeks. 1 FigureDosing schedule for patients in the GAIN study.