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Circulating Brodalumab Levels and Therapy Outcomes in Patients With Psoriasis Treated With Brodalumab: A Case Series

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Importance: Given the possible treatment modalities in psoriasis management, little is known about whether drug monitoring is associated with response rate.

Objective: To determine whether drug monitoring is associated with response to brodalumab therapy.

Design: A multicenter case series study of patients with psoriasis treated with brodalumab whose treatment with previous IL-17A inhibitor therapy failed. Patients were recruited from the Departments of Dermatology at Gentofte and Aarhus University Hospitals, Denmark, between 2018 and 2020. Patient visits were conducted after 4 and 12 weeks of therapy. Patients not achieving Psoriasis Area and Severity Index 75% improvement from baseline (PASI 75) after 12 weeks were discontinued and considered nonresponders. Patients maintaining PASI 75 response were followed up for up to 52 weeks.

Exposure: Treatment with brodalumab, 210 mg, at weeks 0, 1, 2, then every 2 weeks.

Main Outcomes and Measures: Outcome measures were PASI reductions vs brodalumab levels and antibrodalumab antibodies.

Results: Twenty patients with psoriasis (13 [65%] were male; median age, 50 years [range, 19-66 years]) were included. After 12 weeks of therapy, patients with quantifiable levels of brodalumab (≥0.05 μg/mL) experienced significantly higher PASI reductions than those without (median, 93%; range, 61%-100% vs median, -3; range, -49% to 94%, respectively; P = .006). After 12 weeks of therapy, 4 of 5 patients (80%) not achieving PASI 75 had subquantifiable drug levels (<0.05 μg/mL), although this finding was seen for only 3 of 14 PASI 75 responders (21%). None of 7 patients (35%) with subquantifiable drug levels after 12 weeks of therapy maintained response. No antibrodalumab antibodies were detected in any of the tested samples.

Conclusions and Relevance: Results of this case series study suggest that circulating brodalumab level is a factor associated with clinical treatment response. Monitoring patient levels of circulating brodalumab may aid clinical decision-making and help prevent ineffective therapy.

Original languageEnglish
JournalJAMA Dermatology
Volume158
Issue number7
Pages (from-to)762-769
Number of pages8
ISSN2168-6068
DOIs
Publication statusPublished - 1 Jul 2022

    Research areas

  • Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Female, Humans, Male, Middle Aged, Psoriasis/complications, Severity of Illness Index, Treatment Outcome

ID: 78375983