Risankizumab efficacious across racial, ethnic groups
Retrospective study shows comparable efficacy in treating plaque psoriasis (Issue #228; 1,600 words; 8 minutes)
Findings from a retrospective analysis suggest the efficacy of risankizumab as a treatment for moderate-to-severe plaque psoriasis is similar across a range of racial and ethnic groups, with no new safety signals detected.
The findings were published in Dermatology and Therapy (Oct. 2, 2024; 14:2877–2887).
“Historically, patients with skin of colour have been underrepresented in clinical trials and underdiagnosed compared to White patients,” the authors of the paper write in their introduction.
To more directly address efficacy and safety across races and ethnicities, investigators assessed the efficacy and safety of the biologic medication risankizumab in treating adults with moderate-to-severe plaque psoriasis using data from the LIMMitless open-label extension trial.
Patients received continuous treatment with 150 mg risankizumab through their initial trial and the open-label extension. The patients also self-identified their race and ethnicity. Researchers assessed efficacy using the Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) and reported safety by events per 100 patient-years.
For this analysis, the investigators included 897 patients (race: 662 White, 196 Asian, 25 Black or African American, 14 Other; ethnicity: 98 Hispanic or Latino, 799 non-Hispanic or Latino).
Researchers found that, compared to baseline, patients had a mean per cent reduction in PASI between 94.6% (Asian) and 99.3% (Black or African American). They reported mean per cent improvements in DLQI ranging from 87.1% (Asian and Black or African American) to 93.7% (Hispanic or Latino) at week 100.
The authors note that the study cannot detect statistical differences due to the small subpopulations—mainly only 25 patients self-identified as Black or African American—and that scientific conclusions should not be drawn. They also note that severity at baseline was not balanced between races or ethnicities.
“Despite this, patients who identified as Other reported the highest DLQI at baseline. Additionally, these studies did not collect skin phenotype or objective measures of skin pigmentation (e.g., by colorimetry),” they write. “Enrollment in these studies began before the increased awareness of lack of diversity in clinical trials and serves to emphasize the importance of enrolling patients with skin of colour.”
Bottom line: Risankizumab consistently reduced the signs and symptoms of psoriasis and enhanced the quality of life across various racial and ethnic groups, without notable differences in safety profiles among these groups, based on a retrospective analysis.
From the literature on dermatology in skin of colour
Asia-Pacific consensus recommendations on the management of generalized pustular psoriasis
Noting there is limited evidence for the management of generalized pustular psoriasis (GPP) from the patient population in the Asia-Pacific (APAC) region, researchers aimed to identify current evidence and gain advanced insights to facilitate the development of a regionally tailored APAC consensus on the management of GPP.
Investigators conducted a systematic literature review to identify published literature and develop consensus statements on the definition and clinical course, diagnosis of GPP, treatment outcomes, goals, monitoring measures, and optimal management strategies and clinical practices.
A panel of dermatologists rated statements in two rounds, with the threshold for consensus at ≥80% agreement. Twenty experts from the APAC region agreed on 106 statements developed based on the literature review and experts' collective expertise. The experts agreed that GPP is a rare, severe, and potentially life-threatening condition that is distinct from plaque psoriasis. This consensus emphasized the importance of a tailored treatment strategy considering the severity of GPP flares and each patient's unique clinical circumstances. The experts agreed on the severity classification of GPP flares and recommended first-line and maintenance treatment options for adult GPP, childhood GPP, and GPP in pregnancy. These consensus outcomes have been synthesized into treatment algorithms to guide dermatologists in the APAC region in their clinical decision-making processes.
Efficacy and safety of secukinumab in the treatment of psoriasis in patients with skin phototypes IV to VI
To evaluate the safety and efficacy of secukinumab in treating moderate-to-severe plaque psoriasis in adults with Fitzpatrick skin types IV-VI, researchers recruited 20 male and female subjects aged 18 years and older. All patients had body surface area (BSA) involvement of at least 10%, Psoriasis Area and Severity Index (PASI) Scores of 12 or higher, and Investigator’s Global Assessment (IGA) scores of 3 or higher. The total study duration was 28 weeks. During treatment, subjects received secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4, then monthly through week 20.
The investigators found 73% of patients achieved at least 90% improvement in PASI score (PASI 90) at week 16 compared to baseline (p=0.0592). A statistically significant proportion of patients achieved PASI 75, IGA of clear or almost clear, and a change from baseline in DLQI total score at weeks 12, 16, and 24. A statistically significant reduction in IGAxBSA-75 scores was achieved between week 16 and baseline.
The authors identified limitations, including the small sample size—underpowered to detect statistically significant changes in some endpoints—and the interruption of the study by the COVID-19 pandemic, which led to missing data points.
Racial/ethnic differences in biologic treatment patterns among patients with psoriasis: A prospective analysis of patients in the CorEvitas Psoriasis Registry
In this study, researchers investigated biologic management patterns among patients with psoriasis of different racial/ethnic backgrounds six months after initiation of therapy by assessing discontinuation and switching rates in the CorEvitas Psoriasis Registry.
Researchers included 5,500 registry participants who initiated an interleukin (IL)-17 inhibitor, IL-12/23 inhibitor, IL-23 inhibitor, or tumour necrosis factor inhibitor. They had a six-month (five- to nine-month window) follow-up visit between April 2015 and March 2021. Investigators classified the patients by self-identified race/ethnicity: White (non-Hispanic), Black (non-Hispanic), Asian, Hispanic, or Other (Native American, Hawaiian/Pacific Islander, Other, or multiracial).
The authors compared frequencies of discontinuations and switches of therapy that occurred by six months among race/ethnicity groups. They also reported multivariable-adjusted relative risks and 95% CIs for discontinuations and switches for each group relative to Whites.
Across all race/ethnic groups, any differences in demographics, health characteristics, disease characteristics, and biologic-naïve status were small (all w and f < 0.2). Unadjusted (p=0.30) and multivariable-adjusted (p=0.30) discontinuation rates at six months were similar across groups. Unadjusted rates of drug switching differed among groups (overall p<0.01), with Black patients having a lower rate (6.7%) compared with White, Asian, and Hispanic patients (12.0%-16.0%). In adjusted analyses, Black patients were 57% less likely to switch therapy relative to Whites (relative risk: 0.43, 95% CI: 0.26-0.73). Among switchers, Black participants reported the lowest proportion of switching to a different biologic and the greatest proportion of adding a nonbiologic therapy. Overall, more than 90% of switches occurred due to poor response.
The authors conclude their findings suggest different management strategies are used for patients of varying race/ethnicity. They note the reasons for this discrepancy are not yet fully understood but may be partially explained by a greater level of unfamiliarity and apprehension with biologics among Black patients compared with White patients, representation in clinical research, or physician-patient preferences. Clinical presentation of psoriasis can differ across racial/ethnic groups, potentially hindering diagnosis or treatment, and socioeconomic factors may also play a role.
VIDEO: Patient advocate Alisha Bridges talks about plaque and scalp psoriasis on skin of colour
In a video from news outlet Urban Health Today, Alisha Bridges, a patient advocate and influencer with plaque and scalp psoriasis, talks about her experience living with psoriasis as a person of colour and how patients can advocate for themselves to receive the care they deserve.
At the intersection of skin and society
Canadian advocacy organization The Black Women’s Institute for Health is conducting a national survey on the experiences of Black women and girls within the Canadian healthcare system, reports The Toronto Star. The survey, Voices UnHeard, is the first national attempt to collect data by and for Black women on their experiences in the healthcare system.
“I started to look for data here in Canada and couldn’t find anything,” said Kearie Daniel, founder of the Black Women’s Institute for Health, in the article. “I didn’t quite grasp just how severe the lack of data around (Black women and girls’) experiences were.”
For example, the news outlet quoted Dr. Aisha Lofters, a scientist at Women’s College Hospital in Toronto specializing in cancer screening. She noted that efforts have been made to research breast cancer rates disproportionately affecting Black women in the U.S. and the U.K., but very little has been done looking at that in Canada. “We need to understand our particular context and what it means for Black Canadian women,” said Dr. Lofters.
She said some Black women, specifically those who are of West African ancestry—including women from the Caribbean, Nigeria, and Ghana—“seem to be more likely to have more aggressive types of breast cancer.”
Daniel said that the Black Women’s Institute aims to receive at least 3,000 submissions from Black women and girls nationwide. “I really hope Voices UnHeard starts to drive and change the conversation on health care for Black women and girls in Canada.”
Voices UnHeard is open to all Black women and girls 16 and up across Canada and can be found on the organization’s website, bwhealthinstitute.com.
The institute will collect responses by Dec. 30 and create a report that shows the disparities within the healthcare system for Black women and girls across the country.
This week
Dec. 12 is International Universal Health Coverage Day
Dec. 12 is National Workplace Day of Remembrance in the U.K.
Something to think about in the week ahead . . .
—Thomas Henry Huxley, English biologist and anthropologist (1825 – 1895)
Next week
Dr. Andrew Alexis provides an overview of treatment approaches for disorders of hyperpigmentation.
Register for the Indigenous Skin Spectrum Global Summit
Registration is open for the first Indigenous Skin Spectrum Global Summit in Montreal on April 5, 2025.
The Indigenous Skin Spectrum Global Summit is designed to highlight the unique dermatologic challenges facing Indigenous populations worldwide and share expert knowledge on how physicians can support equitable health.
Presentations at the Global Summit will provide updated information on:
Social determinants of health
Supporting rural and remote communities
Diagnosis and treatment of the most common conditions faced by Indigenous patients worldwide
The latest therapies for the management of these conditions
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty that includes Dr. Rachel Pugh (Australia), Dr. Carsten Sauer Mikkelson (Denmark), Dr. Monique Mackenzie (New Zealand), Dr. Anna Chacon (Florida), Dr. Dana Slape (Australia), Dr. Carolyn Jack (Montreal), and other thought leaders.
More details on the Global Summit will appear in future editions of Skin Spectrum Weekly.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Sam Hanna (Toronto), Fiona Lovegrove (London, Ont.), Yuka Asai (Kingston, Ont.), and Maxwell Sauder (Toronto) discuss new treatment options for atopic dermatitis, including topical and injected agents.
Dr. Jeffrey M. Cohen (New Haven, Conn.) describes findings that show an elevated risk of eating disorders among patients with atopic dermatitis.
Drs. Ron Vender (Hamilton, Ont.), Parbeer Grewal (Edmonton), Fiona Lovegrove (London, Ont.), and Sam Hanna (Toronto) provide an overview of essential news in psoriasis therapy, including new oral therapies and the potential to prevent psoriasis from progressing to psoriatic arthritis.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.