Switching to Risankizumab cost-effective and safe for psoriasis patients in case of secukinumab failure

They said those with inadequate response to SEC150 might benefit from a switch to RZB75, both in reduced doses. As per the findings of the study, six patients (85.7%) and one patient (14.2%) achieved PASI ≤3 or ≤1, respectively, at week 16.

The main author wrote to the editor that biologics usage is revolutionary in managing psoriasis. However, higher cost remains a limiting factor.

The gold standards in managing psoriasis are Interleukin (IL)-17 and IL-23 blockers. These are both safe and efficacious.

Secukinumab is an IL-17A blocker. According to package inserts in countries like the US, Japan, and Taiwan, it can be given 150 mg every four weeks after initial loading. It is the only biologic given in reduced doses. The low dosage is valuable for patients with lower body weight and also those who are biologic naïve.

Literature review and studies:

• Real-world data study: Secukinumab 150 mg (SEC150) and 300 mg (SEC300) have comparable responses, as shown in real-world data studies among Chinese patients. There needs to be more data regarding the next option having similar considerations among those using SEC150. Those patients who are not benefitted using secukinumab can switch to other biologics.
• SustalMM study: One of the IL-23 blockers, Risankizumab, has been studied in reduced doses. In the SustaIMM study, there were comparable responses (PASI-75/90 responses) between patients (Japanese population) receiving 75 mg (RZB75, 90/76%) and 150 mg (RZB150, 95/75%) Risankizumab. In Japan, RZB75 is therefore approved every 12 weeks for psoriasis treatment.

• aIMM study: Psoriatic patients who failed SEC300 or ixekizumab reportedly improved after switching to RZB150. PASI ≤3 or ≤1 was achieved by 63.9% and 32.1% of patients, respectively, following 16 weeks after the switch.
• IMMerge study: Comparing efficacy, RZB150 had greater efficacy than SEC300.

The present study included seven Taiwanese patients, six females and one male. The mean age and weight were 47 years and 60 kg, respectively.

The conclusive study points are:

• Four patients (patients A, C, D and G) were biologic naïve. Other patients used biologics before using secukinumab, including etanercept in one patient, adalimumab in two and ustekinumab in two patients, respectively.
• The static Physicians Global Assessment (sPGA) in all patients were 2–3, and the mean PASI of 6.6 ± 4.4 before initiating SEC150.
• The duration of SEC150 usage before the biologic switch was 16 weeks to 4 years. Inadequate response and secondary failure (loss of effectiveness) were the reasons attributed to the switch.
• Without interruption, Six patients switched to RZB75 from SEC150.
• Pertaining to financial concerns, One patient ( D) who stopped SEC150 at week 28 resumed RZB75 one year afterwards with improved PASI from 4.1 to 3.4 at week 40 of risankizumab.
• There were five patients (A, B, E, F and G) with a history of SEC150 usage for more than 52 weeks, out of which three achieved PASI-75, and one had a PASI-100 response at week 52. Nonetheless, they all had secondary failures.

Further explaining, they said SEC150 was replaced with RZB75. Following the drug switch, PASI was decreased in all five patients. All seven patients are still receiving RZB75 currently. Researchers have follow-up data of six patients for more than 52 weeks. Out of these, at week 52, two achieved PASI-100 and three with PASI-90 response at week 52.

Relative to side effects, none of the patients discontinued Risankizumab.

Our study's findings align with the aforementioned aIMM study, they said. Accordingly, those who do not respond well to SEC150 may benefit from switching to RZB75.

They also mentioned the role of body weight in affecting the efficacy of psoriasis treatment, saying Asian patients were 15–20 kg lighter than Caucasians, which may lead to the use of dose reduction for both secukinumab and risankizumab in our patients based on previous research.

Further reading:

Chang-Yu Hsieh, Tsen-Fang Tsai. Effectiveness and safety of reduced-dose secukinumab switching to risankizumab for psoriasis patients in an Asian population: A case series https://doi.org/10.1111/exd.14810