Ustekinumab safe, effective in Asians with moderate to severe plaque psoriasis

Asian patients with moderate to severe plaque psoriasis may benefit from ustekinumab therapy, which has been shown to be both safe and effective in a Singapore study.

“[T]he safety and efficacy of ustekinumab in the treatment of multiethnic Asian patients are comparable to those reported in global studies,” the researchers said.

In this retrospective study, 99 adults with chronic plaque psoriasis were treated with ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. The researchers assessed the proportion of patients achieving at least 50-percent and 75-percent improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at weeks 4 and 16.

Of the patients with plaque psoriasis, 69 percent were Chinese, 15 percent Indians, and 9 percent Malays. Thirty-one patients had recorded PASI scores, and 55 had recorded BSA improvements. [Singapore Med J 2023;64:434-438]

Among patients with documented PASI scores, 29 (93.5 percent) achieved PASI 50 and 21 (67.7 percent) had PASI 75 at week 16. Among those with available BSA, 43 (78.2 percent) achieved at least 50-percent BSA improvement and 31 (56.4 percent) had 75-percent BSA improvement at week 16.

Compared with other biologics, 48 percent of patients treated with etanercept achieved PASI 75 at week 12, 53 percent of those on adalimumab achieved PASI 75 at week 12, 72 percent of those on infliximab achieved PASI 75 at week 10, and 81.6 percent of those on secukinumab achieved PASI 75 at week 12, based on previous studies. [N Engl J Med 2003;349:2014-2022; J Am Acad Dermatol 2006;55:598-606; J Am Acad Dermatol 2004;51:534-542; N Engl J Med 2014;371:326-328]

In terms of safety, none of the patients experienced tuberculosis reactivation, but 11 (11 percent) had latent tuberculosis infection (LTBI) and received treatment with prophylactic isoniazid. In addition, serious adverse events were not reported, and no cardiovascular events, cutaneous malignancies, or deaths occurred over 6 years.

“Ustekinumab was well tolerated by our multiracial population with moderate to severe plaque psoriasis,” the researchers said. “There were no reports of injection-site side effects or serious allergic reactions, or common adverse events including nasopharyngitis, arthralgia, and headache.”

Notably, only one patient experienced upper respiratory tract infection (URTI) following injection. However, information or recall bias was possible, since nasopharyngitis and URTI were commonly reported by 7.3 percent to 11.5 percent and by 4.4 percent to 8.6 percent of patients in ustekinumab-treated groups in prior studies. [Lancet 2008;371:1675-1684; J Dermatol Sci 2011;63:154-163]

The current study was limited by its retrospective design, and only 31 patients had a documented PASI score. Moreover, the low incidence of common adverse events, such as URTI and nasopharyngitis, could be due to information or recall bias.

“Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis,” the researchers said.