Brodalumab vs. Ustekinumab for Psoriasis

Craig A. Elmets, MD reviewing Lebwohl M et al. N Engl J Med 2015 Oct 1.

Both agents are very active against psoriatic skin disease, but brodalumab works more rapidly and is more effective.

The cytokine IL-17 is central to pathogenesis of psoriatic skin disease. Antibodies to IL-17 or to the IL-17 receptor (brodalumab) are approved or in late-stage clinical trials. Cytokine IL-23 has also been implicated in psoriasis; ustekinumab, an antibody to IL-23, is effective and FDA-approved for psoriasis. These authors conducted two phase III trials comparing brodalumab with ustekinumab and placebo in nearly 3500 patients with moderate-to-severe plaque-type psoriasis.

At week 12, approximately 85% of 210-mg brodalumab recipients and 68% of 140-mg brodalumab recipients achieved at least a 75% reduction in the psoriasis area-and-severity index score (PASI 75), compared with 70% of ustekinumab recipients and 6% of placebo recipients. Significantly more 210-mg brodalumab recipients reached PASI 100. Response was more rapid with brodalumab (<3 weeks) than with ustekinumab (>6 weeks). Both drugs continued to be effective through week 52 on maintenance therapy. Nasopharyngitis, headache, arthralgias, neutropenia, and mild or moderate Candida infections were more frequent with brodalumab. One death from stroke occurred in a brodalumab recipient during induction; three deaths in the brodalumab group and two deaths in the ustekinumab group occurred during the maintenance phase.

Citation(s):

Lebwohl M et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med 2015 Oct 1; 373:1318.