Efficacy and Tolerability of Brodalumab in 42 Adult Patients With Moderate to Severe Psoriasis: First French Real-Life Case Series on Hard-to-Treat Areas

Abstract

Background

Psoriatic hard-to-treat areas (scalp, palmoplantar, genital and nails) are associated with lower efficacy, treatment discontinuation and impaired quality of life. Recent biotherapies offer a new perspective for their treatment. Among them brodalumab is indicated for the treatment of moderate-to-severe plaque psoriasis in adults requiring systemic therapy. No French data are available on the effectiveness of brodalumab on hard-to-treat areas.

Objectives

To assess the effectiveness and safety of brodalumab in real life on psoriatic hard-to-treat areas.

Methods

Retrospective multicenter study including 42 psoriasis adults which received at least one injection of brodalumab from January 2022 through May 2024 and were followed for a minimum period of 2 months after initiation. Scores were collected at baseline and between 2 and 20 months after treatment initiation: BSA (body surface area), PASI (psoriasis area severity index), PGA-G (Physician's Global Assessment of genitalia), ppPASI (Palmoplantar Psoriasis Area and Severity Index), NAPSI (Nail Psoriasis Severity Index) and PSSI (Psoriasis Scalp Severity Index). DLQI (Dermatology Life Quality Index) was calculated to assess the impact on quality of life. Tolerance and potential adverse events were reported.

Results

The mean BSA at baseline was 16.3%; mean baseline scores: PASI 11.9; PGA-G 2.3; ppPASI 14.9; NAPSI 16.3; PSSI 20.2. 92.9% of patients had DLQI ≥ 10. All patients had hard-to-treat areas: scalp 69.0%; nail 50.0%; genital 50.0%; palmoplantar 35.7%. At the end of the follow-up, the mean scores were, respectively: PASI 0.8; PGA-G 0.3; ppPASI 1.1; NAPSI 2.2; PSSI 1.2. PASI < 1 was achieved by 69.0% of patients. Adverse events were reported in 9.5% of patients.

Conclusions

Brodalumab demonstrated clinical efficacy on hard-to-treat areas in just 3 months of treatment, with a median treatment duration of 4.0 months. This important and rapid clinical efficacy was associated with an improvement in quality of life and good tolerance.