Clinical, Cosmetic and Investigational Dermatology (Jul 2019)
Brodalumab for the treatment of moderate-to-severe psoriasis: case series and literature review
Abstract
Andreas Pinter,1 Bernd Bonnekoh,2 Ina Marion Hadshiew,3 Sebastian Zimmer41Department of Dermatology, Venereology, and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; 2Clinic for Dermatology, Otto-von-Guericke-University Hospital, Magdeburg, Germany; 3Derma Köln am Heilig-Geist-Krankenhaus, Köln, Germany; 4MediCorium, Oberursel, GermanyAbstract: Brodalumab, a recombinant fully human monoclonal immunoglobulin IgG2 antibody with high affinity to human interleukin (IL)-17RA, is approved for the treatment of moderate-to-severe plaque psoriasis. In controlled clinical trials, brodalumab 210 mg administered by subcutaneous injection at weeks 0, 1, and 2, then 210 mg every 2 weeks, produced a rapid onset and sustained clinical response. Consistently, >80% of patients achieved PASI-75 and efficacy was maintained for >2 years. The benefits are apparent soon after the start of therapy and are maintained in the long term. Such results, from the reviewed literature, support the findings from 4 ’real world’ cases in mainstream clinical practice which are reported here. Psoriatic plaques, including on the scalp, nails, soles and palms, were largely resolved, and quality of life improved markedly. Therapeutic success was achieved in patients naïve to biologics (2 cases) and in those responding inadequately to other biologics (2 cases). The high affinity of brodalumab to human IL-17RA blocks the biological activities of the pro-inflammatory cytokines IL-17A, IL-17C, IL-17E, IL-17F, and IL-17A/F heterodimer, resulting in inhibition of the inflammation and clinical symptoms associated with psoriasis. This mechanism of blocking multiple IL-17 family cytokines differs from that of other available biologics which selectively target some parts of the Th-17 axis and may account for the effectiveness of brodalumab in patients poorly responsive to other biologics, a feature which has also been shown where subgroup analysis has been undertaken in clinical trials. The drug is well tolerated during the normal 12-week induction phase and with prolonged treatment (52 to 120 weeks), as it was in the current case series.Keywords: brodalumab, psoriasis, psoriatic arthritis, interleukin 17 axis, IL-17
