Circulating levels of brodalumab tied to therapy outcomes in psoriasis patients: Study

Denmark: Circulating brodalumab level is a factor associated with clinical treatment response in patients with psoriasis, states case series study results published in JAMA Dermatology. Monitoring levels of circulating brodalumab in psoriasis patients may help clinical decision-making towards the prevention of ineffective therapy, the study suggests.

Psoriasis is a serious global problem, affecting at least 100 million individuals of all ages, and in all countries. With recent advances, many possible treatment modalities in psoriasis management are available but estimating the ideal treatment choice for each patient is a challenge. There are no validated, clinically useful biomarkers and so treatment modalities are generally applied on a trial-and-error basis. Brodalumab, a human monoclonal antibody to the interleukin-17A receptor, which acts as an immunosuppressant may be considered as first-line therapy in Psoriasis and also as rescue therapy in patients refractory to treatment.

A multicenter case series study was performed by Christian Enevold, Copenhagen University Hospital, Denmark, and colleagues to assess whether brodalumab levels are associated with clinical response, as measured by reductions in Psoriasis Area and Severity Index (PASI), and can be used as a marker of long term response.

They measured trough levels of circulating brodalumab and antidrug antibodies in 20 consecutive patients with prior failure to anti–IL-17A therapy, who had baseline PASI score of 6 or higher and had not received concomitant systemic treatment for psoriasis,

Researchers administered Brodalumab, 210 mg, at weeks 0, 1, 2, and then every 2 weeks to patients and conducted patient visits after 4 and 12 weeks of therapy. Patients maintaining PASI 75 response were followed up for up to 52 weeks.

Data results after 12 weeks of therapy showed that,

• Patients with quantifiable levels of brodalumab (≥0.05 μg/mL) experienced significantly higher PASI reductions than those without.

• 4 of 5 patients (80%) not achieving PASI 75 had subquantifiable drug levels (<0.05 μg/mL), notably this was seen for only 3 of 14 PASI 75 responders (21%)

• None of 7 patients (35%) with subquantifiable brodalumab levels were associated with a lack of response at a statistically significant level.

• Antibrodalumab antibodies were not detected in any of the samples.

Researchers conclude that circulating trough levels of brodalumab were associated with concomitant response, and subquantifiable brodalumab levels after 12 weeks of therapy identified long-term nonresponders, at least in patients with previous response failure to other biological treatments.

Reference:

Enevold C, Loft N, Bregnhøj A, et al. Circulating Brodalumab Levels and Therapy Outcomes in Patients With Psoriasis Treated With Brodalumab: A Case Series. JAMA Dermatol. Published online June 01, 2022. doi:10.1001/jamadermatol.2022.1863