Impact of previous biologic use on the efficacy and safety of brodalumab and ustekinumab in patients with moderate‐to‐severe plaque psoriasis: integrated analysis of the randomized controlled trials AMAGINE‐2 and AMAGINE‐3

Summary Background Biologics are being used increasingly to treat moderate‐to‐severe psoriasis. Efficacy may differ in patients with previous exposure to biologics. Objectives To investigate the impact of previous biologic exposure on the efficacy and safety of brodalumab and ustekinumab in patients with moderate‐to‐severe plaque psoriasis. Methods Two placebo‐ and ustekinumab‐controlled phase III clinical trials. There was an initial 12‐week induction phase where patients were treated with brodalumab [210 mg or 140 mg every 2 weeks (Q2W)], ustekinumab or placebo. Efficacy end points included ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) and static Physician's Global Assessment (score of 0 or 1) vs. placebo, PASI 100 vs. ustekinumab, Dermatology Life Quality Index and Psoriasis Symptom Inventory. Adverse events were monitored throughout. Results In total, 493 patients [334 (27%) brodalumab 210 mg Q2W and 159 (26%) ustekinumab] had received prior biologics; 150 (12%) and 62 (10%), respectively, reported previously failed treatment with a biologic. Brodalumab efficacy in patients with or without previous exposure to biologics was statistically equivalent: 40·9% and 39·5% of biologic‐naive and ‐experienced patients achieved PASI 100 at week 12, compared with 21·1% and 17·0% with ustekinumab (both P