Siliq / Kyntheum vs fumaric acid esters

[Fred]

This study compared Siliq / Kyntheum (brodalumab) to fumaric acid esters (FAE) in terms of clinical efficacy, patient‐reported outcomes, and safety.

Quote:

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Background:
Brodalumab is a fully human monoclonal immunoglobulin IgG2 antibody that binds to the human IL‐17 receptor subunit A and by that inhibits the biologic action of IL‐17A, 17F, 17C, and 17E. Therapy with fumaric acid esters (FAE) is a well‐established and widely used first‐line systemic treatment for subjects with moderate‐to‐severe plaque psoriasis

Objectives:
To compare brodalumab to FAE in terms of clinical efficacy, patient‐reported outcomes, and safety in subjects with moderate to severe plaque psoriasis who were naïve to systemic treatment.

Methods:
Eligible subjects were randomised 1:1 to 210 mg brodalumab injections or oral FAE according to product label in this 24‐week, open‐label, assessor‐blinded, multi‐centre, head‐to‐head phase 4 trial. The primary endpoints were having PASI75 and having sPGA score of 0 or 1 (sPGA 0/1). Subjects with missing values for the primary endpoints were considered non‐responders.

Results:
A total of 210 subjects were randomised. 91/105 subjects completed brodalumab treatment and 58/105 subjects completed FAE treatment. At Week 24, significantly more subjects in the brodalumab group compared to the FAE group had PASI75 (81.0% vs. 38.1%, p<0.001) and sPGA 0/1 (64.8% vs. 20.0%, p<0.001). In the brodalumab group, the median time to both PASI75 and to PASI90 was significantly shorter than in the FAE group (4.1 weeks vs. 16.4 weeks, and 7.4 weeks vs. 24.4 weeks, respectively, p<0.0001 for both). The rate of adverse events was lower in subjects treated with brodalumab compared to subjects treated with FAE (616.4 vs. 1195.8 events per 100 exposure years). No new safety signals were detected for brodalumab.

Conclusions:
Brodalumab was associated with rapid and significant improvements in signs and symptoms of moderate‐to‐severe plaque psoriasis, with a superior efficacy profile to what was observed with FAE in systemic‐naïve subjects over 24 weeks.

Source: onlinelibrary.wiley.com

*Early view funding unknown

[Caroline]

Easy comparison. No need to measure this. DMF is a slow burner, Bio’s are always quick. So a bit cowardly to compare.

No... lets compare the costs... then it suddenly changes. And lets compare the long term time that you can use it, I will be curious.

And, lets compare the working... the Bio is a suppressor, DMF is an addition and touches the fundamental cause of psoriasis. 

But .. DMF can still be better if it has slow release, but the producer of Skilarence is not there yet, they are very slow in logical thinking.

[jiml]

I agree with Caroline that FAEs are slow to work but if they do work they can be a long term treatment. Although I see in the study that a lot of the FAE users dropped out and sadly it's true that many give up with FAEs because of the side effects
A thought of mine while reading this was did the ones on FAEs start on a low dose because if they did it would be several weeks before they were on full dose and it begins working

[Bill]

Agree with Jim and Caroline. An apple and oranges comparison is pretty meaningless unless you want a predetermined outcome. For those who respond well to DMF treatment the outcome is frequently excellent and long term, often with increasing efficacy and decreasing dosage. The problems we face as sufferers is in not knowing what will work and the wait between treatments.

Cheers