PracticeUpdate: Dermatology - Winter 2018

CONFERENCE COVERAGE 24

International Investigative Dermatology 2018 Meeting 16–19 MAY 2018 • ORLANDO, FLORIDA, USA By the PracticeUpdate Editorial Team Secukinumab Reduces CD4-Positive Th17, AsWell As CD8- and CD4-Positive Treg Cells in PatientsWith Plaque Psoriasis Secukinumab has been found to reduce not only CD4-positive Th17, but also CD8- and CD4-positive T-regulatory (Treg) cells in patients with plaque psoriasis. This finding of a flow cytometry study to characterize changes in immune cell populations in psoriatic lesions treated with secukinumab was reported at IID 2018. E ric J. Yang, MD, of the University of California in San Francisco, explained that psoriasis is a chronic inflamma- open-label, 5-year extension to the core phase III SCULPTURE study. At year 1, 89% and 69%, respectively, of 168 patients with psoriasis achieved PASI 75 and 90. This high rate was maintained at year 5 with 126 patients observed (89% and 66%, respectively).

Courtesy of IID 2018

In SCULPTURE, Psoriasis Area and Severity Index (PASI) 75 responders at week 12 were randomized to double-blind maintenance treatment of 300 or 150mg of secukinumab, given in either a 4-week fixed-interval regi- men or in a retreatment-as-needed regimen. Patients who completed 52 weeks of the SCULPTURE study were eligible to con- tinue the same dose and regimen in the extension study (n=642). The primary objective of the extension study was to assess the long-term safety and tolerability of secukinumab in patients with moderate to severe plaque psoriasis. Efficacy measures included proportion of patients achieving PASI 75/90/100. Over an extended treatment period from year 1 (week 52) to the end of year 5 (week 260), PASI 75/90/100 response rates remained consistent.

tory skin disease that involves widespread immune dysregulation. Cell populations implicated in psoriasis include keratino- cytes, dendritic cells, and Th17 cells. These produce excess tumor necrosis factor α, and interleukins 17 and 23. Studies evaluating the impact of biologics on the molecular profile of psoriasis have used bulk skin tissue and have demon- strated broad changes that occurred in lesioned skin. Secukinumab, approved for plaque pso- riasis in 2015, is a recombinant human monoclonal IgG1/κ antibody that binds spe- cifically to interleukin 17A. In 2017, 5-year data were reported on secukinumab for moderate to severe plaque psoriasis. The 5-year extension study was a multicenter, double-blind,

In addition, 44% of patients with psoriasis achieved completely clear skin (PASI 100) at year 1. This rate was maintained to year 5 (41%). The safety profile continued to exhibit a favorable and consistent safety profile. In the present study, Dr. Yang and col- leagues used a novel flow cytometry protocol based on protein expression to analyze individual cell population activity in skin disease. They characterized changes in immune cell populations in psoriatic lesions treated with secukinumab, an inter- leukin 17A inhibitor. Lesional skin biopsies of 11 patients with psoriasis were obtained at weeks 0, 2, 4, and 12 of secukinumab treatment. They were analyzed via flow cytometry and

PRACTICEUPDATE DERMATOLOGY