Real-World Clinical Experience of Secukinumab in Chinese Patients with Psoriasis: A 36-Week Single-Center Study of 24 Patients
Psoriasis is a chronic autoimmune inflammatory disease that imposes significant physical and psychological burdens on patients. The interleukin (IL)-17A pathway plays a central role in its pathogenesis, making IL-17A inhibitors like secukinumab a cornerstone of modern therapy. Secukinumab, a fully human monoclonal antibody targeting IL-17A, was approved in China in March 2019 for moderate-to-severe plaque psoriasis (PsV). While randomized controlled trials (RCTs) established its efficacy and safety, real-world data in Chinese populations remain scarce. This 36-week retrospective study evaluated the real-world performance of secukinumab in 24 Chinese patients with psoriasis, including PsV and generalized pustular psoriasis (GPP), at a single center in Fujian Province.
Study Design and Patient Characteristics
The study enrolled 24 consecutive patients (18 with PsV, 6 with GPP) treated with secukinumab between July 2019 and July 2020. Patients were followed for 36 weeks, with outcomes assessed through Psoriasis Area and Severity Index (PASI), Generalized Pustular Psoriasis Physician Global Assessment (GPPGA), and Dermatology Life Quality Index (DLQI) scores. Baseline demographics revealed a significantly younger age of onset in GPP patients compared to PsV patients (19.0 ± 13.25 vs. 37.06 ± 14.99 years; P = 0.016), a finding attributed to heightened parental awareness of childhood GPP in China. Body mass indices and comorbidities were also analyzed, though small sample sizes limited subgroup analyses.
Efficacy in Plaque Psoriasis (PsV)
Secukinumab demonstrated rapid and robust efficacy in PsV patients. By week 12, 89% achieved ≥75% improvement in PASI (PASI-75), while 67% achieved ≥90% improvement (PASI-90). By week 36, 78% of PsV patients achieved complete clearance (PASI-100). Notably, scalp psoriasis resolved fastest, with 100% achieving ≥75% improvement in scalp-specific PASI (PSSI-75) by week 12. In contrast, palmoplantar and nail psoriasis showed slower responses. Palmoplantar PASI (ppPASI)-75 was achieved by 80% at week 12, while only 29% of patients with nail involvement attained PASI-75 by week 36. These regional disparities highlighted the challenges of treating psoriasis in areas with poor blood supply or structural complexity.
Efficacy in Generalized Pustular Psoriasis (GPP)
In GPP patients, secukinumab induced rapid pustule clearance. By week 4, all patients (100%) achieved ≥75% improvement in GPPASI (GPPASI-75), escalating to 83% GPPASI-90 and 50% GPPASI-100 by week 12. By week 36, all GPP patients achieved complete clearance (GPPASI-100). This aligns with phase III Japanese trials, where secukinumab led to sustained remission in GPP. The study posits secukinumab as a first-line therapy for GPP due to its unique efficacy against pustular and erythematous lesions.
Impact on Quality of Life
Dermatology Life Quality Index (DLQI) scores improved significantly across all patients. Baseline DLQI decreased from 13.17 to 1.21 by week 36, with 75% achieving a DLQI of 0/1 (no or minimal impact on quality of life). Linear regression analysis revealed no direct correlation between PASI/GPPASI improvement and DLQI reduction (r² = 0.9995 and r² = 0.9165, respectively), suggesting secukinumab enhances quality of life through mechanisms beyond mere lesion clearance, such as alleviating psychosocial distress.
Regional Variability in Treatment Response
The study emphasized differential responses across body regions. Scalp lesions resolved fastest, with PSSI-75 achieved by 100% at week 12, compared to slower responses in palmoplantar regions (P = 0.002 at week 2). Whole-body PASI improvements initially lagged behind scalp responses but caught up by week 12. Nail psoriasis exhibited the poorest response, underscoring the need for adjunct therapies in refractory areas.
Safety Profile
Secukinumab was well-tolerated, with no severe adverse events reported. Common side effects mirrored those in RCTs, including mild upper respiratory infections and injection-site reactions. The safety profile in Chinese patients aligned with global data, reinforcing secukinumab’s favorable risk-benefit ratio.
Dosage Considerations
Both 150 mg and 300 mg secukinumab doses were used, with no significant differences in efficacy (P = 0.13). This non-inferiority suggests that lower doses may suffice for some patients, potentially reducing costs and side effects.
Clinical Implications and Future Directions
This study provides critical real-world evidence supporting secukinumab’s use in Chinese psoriasis patients. Its rapid action, especially in GPP and scalp psoriasis, positions it as a first-line biologic. However, slower responses in palmoplantar and nail regions highlight unmet needs. Future studies with larger cohorts and longer follow-up are needed to validate these findings and explore combination therapies for resistant cases.
Conclusion
Secukinumab demonstrated high efficacy and safety in Chinese patients with PsV and GPP over 36 weeks. Complete clearance rates of 78% (PsV) and 100% (GPP), coupled with significant quality-of-life improvements, underscore its value in real-world practice. Regional response variability calls for tailored treatment strategies, while the favorable safety profile reinforces its role as a cornerstone therapy.
doi.org/10.1097/CM9.0000000000001259
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