Early Intervention with Ixekizumab Yields Superior PASI Responses

A new study has evaluated how ixekizumab performs among plaque psoriasis severities.¹ After assessing clinical efficacy, disease recurrence rate, and drug retention, it was found that the drug demonstrated better performance in patients with mild to moderate disease.

Background

Ixekizumab is a humanized monoclonal antibody that targets IL-17A to disrupt the key inflammatory pathways related to psoriasis.² It is currently approved in China for adult patients with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. According to the authors, previous research on biologic therapies primarily focuses on moderate-to-severe plaque psoriasis rather than mild-to-moderate severity. This research aims to address this, along with knowledge gaps regarding early intervention and how it may impact disease progression or relapse.

Methods & Materials

The multicenter, retrospective, real-world study analyzed clinical records of 354 adult patients at 10 centers who were included in the China Psoriasis Biologics Chronic Disease Registry System database. This included 255 males (72.0%) and 99 females (28.0%), with a mean age of 40 years. Patients were diagnosed with either mild-to-moderate or severe psoriasis before being treated with ixekizumab. Investigators collected baseline data on demographics, lifestyle factors, disease duration and severity, family history, comorbidities, and the presence of arthritis involvement.

Clinicians assessed Psoriasis Area and Severity Index (PASI) response rates, absolute PASI values, drug retention, and recurrence rates across 2, 4, 12, 24, and 52 weeks. More specifically, researchers focused on the proportion of patients achieving PASI 75, 90, and 100 responses along with the absolute PASI values at each visit.

Those in the mild-to-moderate group (n = 184) had a PASI of <10, with a baseline average of 5.6. Those in the severe group (n = 170) had a PASI of ≥ 10, with a baseline average of 20. There was also a higher proportion of males in the severe cohort (86.5% vs. 58.7%, p < 0.001). Mean disease duration in all patients was an average of 10.6 years and 13% also had psoriatic arthritis.

Results

All patients saw a reduction in PASI scores after 52 weeks of ixekizumab therapy, with improvement being observed as early as 2 weeks. After a year, the proportion of participants achieving PASI75, PASI90, and PASI100 were 96.2%, 90.6%, and 69.8%, respectively. These increased steadily over the study.

In the mild-to-moderate group, patients demonstrated superior PASI75/90 responses at most of the time points. These participants also had consistently higher PASI100 rates across 52 weeks (all p < 0.05) and achieved lower residual disease activity.

In the severe disease cohort, higher PASI75/90 response rates were seen only at 12 and 24 weeks. Differences in PASI75/90/100 response rates between both cohorts did not reach statistical significance. Additionally, the severe cohort exhibited a longer median retention duration and treatment persistence (median: 228 weeks) compared to mild-to-moderate patients (p = 0.007).

Recurrence rates and relapse times were comparable in both groups with no statistically significant differences. Recurrence occurred in 11 patients in the severe group (mean time: 199 days) and 4 patients in the mild-to-moderate group (mean time: 162 days).

“The comparable relapse rates between severity groups (p = 0.571) suggest consistent durability of ixekizumab response across disease stages, though extended observation beyond 3 years may be necessary to identify potential late divergence in relapse patterns,” the authors wrote.

Conclusion

With superior PASI responses in those with moderate disease, the researchers suggest that early biologic intervention may optimize long-term outcomes and effectively manage psoriasis. This may lead to lessened lesion severity, lowered inflammatory burden, the reduction of long-term cutaneous risks, and an overall improvement of quality of life.

References

1. Qiao Z, Chai B, Chen Y, et al. Clinical efficacy, drug retention and recurrence of ixekizumab across psoriasis severities: a multicenter retrospective analysis of 354 patients. J Dermatolog Treat. 2025;36(1):2562299. doi:10.1080/09546634.2025.2562299

2. Blegvad C, Skov L, Zachariae C. Ixekizumab for the treatment of psoriasis: an update on new data since first approval. Expert Rev Clin Immunol. 2019;15(2):111-121. doi:10.1080/1744666X.2019.1559730