Journal Club Review: Ixekizumab vs. Guselkumab in Plaque Psoriasis (12-Week Trial Results)

Join Jessica Farrell, PharmD, a clinical pharmacist at Albany Med’s Division of Dermatology and professor at Albany College of Pharmacy and Health Sciences, as she explores a key head-to-head clinical trial comparing Ixekizumab (IL-17 inhibitor) vs. Guselkumab (IL-23 inhibitor) for moderate-to-severe plaque psoriasis. This British Journal of Dermatology study, published in December 2019, provides essential insights into efficacy, safety, and speed of response, making it a valuable resource for healthcare providers treating psoriasis.

The study focused on patients with significant psoriasis severity, defined by Static Physician Global Assessment (sPGA) scores of 3 or higher, Psoriasis Area and Severity Index (PASI) scores above 12, and at least 10% body surface area (BSA) involvement. Participants were randomized to receive either Ixekizumab or Guselkumab at their FDA-approved dosing regimens, with a primary endpoint of 100% PASI improvement (PASI 100) at Week 12.

Results revealed a clear difference in speed of response. By Week 12, 41% of patients on Ixekizumab achieved PASI 100, compared to 25% on Guselkumab, a statistically significant difference. Even more compelling, PASI 50 was reached as early as Week 1 in the Ixekizumab group, and PASI 75 was achieved by Week 2, reinforcing its potential as a rapid-acting psoriasis treatment. These findings are critical for patients who are eager to see visible skin improvements quickly, particularly those who experience severe itching, scaling, and emotional distress due to their condition.

Dr. Farrell emphasizes that head-to-head trials are rare in dermatology, making this study highly valuable when considering treatment sequencing in plaque psoriasis. Choosing between IL-17 and IL-23 inhibitors depends on several factors, including mechanism of action, patient history, treatment goals, and potential adverse effects. The study also confirmed that both medications maintained a favorable safety profile, with no new safety concerns emerging during the trial.

For patients with moderate-to-severe plaque psoriasis, access to fast-acting, effective therapies is crucial. With studies like this, healthcare providers can make more informed decisions when prescribing biologic therapies for psoriasis, ensuring that patients receive the most effective treatment tailored to their needs.

For more expert insights into psoriasis management, biologic therapies, and rheumatology advancements, visit RhAPP.org or explore the RhAPP ACE App.