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Background: Many national guidelines at the European level recommend first‐line therapy based on the anti‐TNF‐alpha adalimumab for treatment of psoriasis and psoriatic arthritis, mainly for economic reasons. Consequently, patients being treated with newer IL‐17 and IL‐23 inhibitors underwent previous unsuccessful first‐line adalimumab‐based therapy. Objectives: Evaluate the efficacy and safety of IL‐17 and IL‐23 inhibitors after treatment with adalimumab compared to adalimumab‐naive psoriatic patients. Methods: We retrospectively analysed 1053 psoriatic patients treated with anti‐IL17 and anti‐IL23 agents, which included 68 and 24 adalimumab‐experienced and 399 and 260 bio‐naive patients. Efficacy was assessed with mean PASI, PASI90, PASI100, and <3. Results: Concerning the achieving of PASI100, PASI90 and PASI < 3 in patients treated with anti‐IL17 agents, no significant differences were observed between adalimumab‐experienced and bio‐naive patients. In patients treated with an anti‐IL‐23 agent, a faster response was observed in bio‐naive patients, with PASI < 3 significantly higher than ADA‐experienced patients at 16 weeks (77% vs. 58% p = 0.048). In a sub‐analysis that evaluated the performance of anti‐IL17 and anti‐IL23 agents in adalimumab‐experienced patients with a history of secondary failure, no significant differences were found. In multivariate analysis of PASI100, only anti‐IL‐17 therapy appeared to have a negative impact at 52 weeks (OR: 0.54 p = 0.04) independently of previous treatment. For PASI90, type of treatment and bio‐naïve status did not seem to have an impact at any time point. Conclusions: Anti‐IL 23 and anti‐IL 17 agents are not significantly different in terms of efficacy in bio‐naive patients or as second‐line therapy after failure with a biosimilar or originator adalimumab. [ABSTRACT FROM AUTHOR]

This is because bio-naïve patients are candidates for biological treatment with a higher PASI than bio-experienced patients who have taken risankizumab following initial secondary inefficacy. Bio-experienced patients achieved PASI90 less than bio-naïve (40.41% vs. 55%, I P i = 0.041) at 16 weeks, differences was also detected in PASI90, 75 and PASI < 3 at week 28 between the two populations (65% vs. 84%, 77% vs. 93% and 78% vs. 91%, I P i = 0.003, I P i = 0.001 and I P i = 0.011 respectively). Effect of Risankizumab on patient-reported outcomes in moderate to severe psoriasis: the UltIMMa-1 and UltIMMa-2 randomized clinical trials. [Extracted from the article]

These results were maintained at week 24, showing a higher rate of patients achieving PASI 90, PASI < 3 and PASI 100 responses in the ixekizumab group. A statistically significant difference was observed at week 48, where PASI 90, PASI < 3 and PASI 100 response rates were achieved by 4 (31%), 6 (46%) and 3 (23%) in the secukinumab group; and 4 (100%), 4 (100%) and 3 (75%) in the ixekizumab group respectively. In the PP group, the outcomes at 12 weeks showed that ixekizumab is faster than secukinumab in achieving PASI 90, PASI < 3 and PASI 100, yet without achieving statistically significant difference: a PASI 90 response was achieved by 29% of patients treated with secukinumab and 50% of patients treated with ixekizumab, while a PASI 100 response was achieved in the two groups by 29% and 33% of patients respectively. At week 48, a statistically significant difference in achieving PASI 90, PASI < 3 and PASI 100 response (100%, 100% and 75% of patients treated with ixekizumab achieved PASI 90, PASI < 3 and PASI 100, vs. 31%, 46% and 23% of patients treated with secukinumab respectively) was observed ( I P i = 0.01; Fig. [Extracted from the article]

Ixekizumab showed significantly higher efficacy in terms of PASI 90 at week 24, and a higher superiority of PASI 90 and PASI 100 also at week 48. In bio-naive patients, we found a significantly higher rate of PASI-90, PASI < 3 and PASI-100 with ixekizumab compared to the secukinumab ( I P i < 0.05), while in bio-experienced patients no significant difference was observed. There was no difference between the two drug survival curves among the two treatment arms. gl PASI-90 and PASI-100 response rates were achieved at week 12 by 124 (48%) and 108 (42%) in the secukinumab group ( I P i = 0.001), while 118 (64%) and 100 (54%) in the ixekizumab group ( I P i = 0.014) respectively (Figure 1b). [Extracted from the article]