Martin A. Menter M.D.

Elmets, C. A., N. J. Korman, E. F. Prater, E. B. Wong, R. N. Rupani, D. Kivelevitch, A. W. Armstrong, C. Connor, K. M. Cordoro, D. M. R. Davis, B. E. Elewski, J. M. Gelfand, K. B. Gordon, A. B. Gottlieb, D. H. Kaplan, A. Kavanaugh, M. Kiselica, D. Kroshinsky, M. Lebwohl, C. L. Leonardi, J. Lichten, H. W. Lim, N. N. Mehta, A. S. Paller, S. L. Parra, A. L. Pathy, M. Siegel, B. Stoff, B. Strober, J. J. Wu, V. Hariharan and A. Menter (2020). “Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures.” J Am Acad Dermatol 2020 Jul 30;S0190-9622(20)32288-X. [Epub ahead of print.].

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Psoriasis is a chronic, inflammatory, multisystem disease which affects up to 3.2% of the U.S population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine (AM) will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.

Menter, A., A. Armstrong, A. Van Voorhees, C. Liu and A. Jacobson (2020). “Brodalumab to the Rescue: Efficacy and Safety of Brodalumab in Patients with Psoriasis and Prior Exposure or Inadequate Response to Biologics.” Dermatol Ther (Heidelb) Jun 12. [Epub ahead of print.].

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While biologic therapies for psoriasis are effective for many patients, some patients may lose response, have inadequate control of disease, or develop intolerance to certain biologic agents. It may therefore be beneficial for patients whose psoriasis fails to respond to one biologic to switch to a different biologic therapy, in particular one with a different mechanism of action. However, it remains unclear how prior biologic exposure or lack of response affects the efficacy and safety of subsequent biologics in patients with moderate-to-severe psoriasis. Brodalumab, a fully human anti-interleukin-17 receptor A monoclonal antibody, has previously been shown to be efficacious in treating moderate-to-severe psoriasis in three large phase 3 trials (AMAGINE-1, AMAGINE-2, and AMAGINE-3). In this review, we summarize the efficacy and safety of brodalumab in patients with moderate-to-severe psoriasis and a history of biologic exposure. Further, we describe improvements in skin clearance and quality of life measures as well as safety in patients who had inadequate response to ustekinumab and who were rescued with brodalumab therapy. Lastly, we discuss improvements in skin clearance following rescue with brodalumab in patients whose disease failed to respond to secukinumab and ixekizumab. The findings of our review suggest that brodalumab is a safe and efficacious treatment regardless of past biologic use or lack of response to prior biologic therapy.

Menter, M. A., G. J. Murakawa, H. Glover, A. M. Mendelsohn, J. Parno, S. J. Rozzo, D. Davidson and A. K. Gupta (2020). “Clearance of head and neck involvement in plaque psoriasis with tildrakizumab treatment in the phase 3 reSURFACE 1 study.” J Eur Acad Dermatol Venereol May 20. [Epub ahead of print].

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Scalp, face, and neck involvement in psoriasis negatively impacts patient quality of life.(1-3) In the phase 3 double-blind, randomised, placebo-controlled reSURFACE 1 trial (NCT01722331), Psoriasis Area and Severity Index (PASI) response rates in patients with moderate to severe plaque psoriasis were high and durable following treatment with interleukin (IL)-23p19 inhibitor tildrakizumab, with acceptable safety.(4

Armstrong, A. W., A. Blauvelt, J. J. Crowley, K. B. Gordon, G. G. Krueger, J. G. Krueger, J. M. Sobell, B. E. Strober, B. Srivastava and A. Menter (2020). “Defining drug-free remission of skin disease in patients with plaque psoriasis.” Br J Dermatol 182(6): 1484-1487

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We conducted an investigator-initiated, consensus-building exercise to develop a practical definition of drug-free remission of skin disease for plaque psoriasis based on the Delphi method, which is a process by which group communication among a panel of experts helps attain consensus on complex issues. The Delphi method has been used to build consensus on other areas of clinical importance in psoriasis, such as the treat-to-target guidelines recently published by the National Psoriasis Foundation. [No abstract; excerpt from article].

Strober, B., A. Menter, C. Leonardi, K. Gordon, J. Lambert, L. Puig, H. Photowala, M. Longcore, T. Zhan and P. Foley (2020). “Efficacy of Risankizumab in Patients with Moderate-to-Severe Plaque Psoriasis by Baseline Demographics, Disease Characteristics and Prior Biologic Therapy: An Integrated Analysis of the Phase III UltIMMa-1 and UltIMMa-2 Studies.” J Eur Acad Dermatol Venereol Apr 22. [Epub ahead of print].

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BACKGROUND: Risankizumab is a humanized IgG monoclonal antibody that selectively inhibits interleukin-23 through binding the p19 subunit. In Phase 3 trials, risankizumab demonstrated superior efficacy compared with adalimumab and ustekinumab in patients with moderate-to-severe plaque psoriasis. Here, we evaluated the impact of baseline characteristics on efficacy of risankizumab compared with ustekinumab in patients with moderate-to-severe plaque psoriasis. METHODS: This analysis included all patients initially randomized to risankizumab or ustekinumab from the replicate, double-blinded, randomized, placebo-controlled phase 3 trials, UltIMMa-1 (NCT02684370) and UltIMMa-2 (NCT02684357). Patients received either risankizumab (150 mg) or ustekinumab (weight-based; 45 or 90 mg per label) at weeks 0, 4, 16, 28, and 40. Efficacy was assessed as the proportion of patients achieving >/=90% improvement in Psoriasis Area and Severity Index (PASI 90) at weeks 16 and 52 by baseline patient demographics, disease characteristics, and prior biologic exposure. Mean percent improvement in PASI was calculated by body weight and body mass index at week 52. Missing efficacy data were imputed as non-responders for categorical variables and last observation carried forward for continuous variables. Logistic regression analyses assessed for interactions between treatment and five independent variables (age, sex, weight, baseline PASI score, and presence of psoriatic arthritis) at both weeks 16 and 52. RESULTS: Baseline patient demographics, disease characteristics and prior biologic exposure were similar between patients randomized to risankizumab (n=598) and ustekinumab (n=199). At weeks 16 and 52, risankizumab demonstrated superior efficacy compared with ustekinumab across these patient characteristics (P<0.01). Logistic regression analyses demonstrated that risankizumab was superior to ustekinumab at weeks 16 and 52 in all models tested (P<0.0001 for all). CONCLUSIONS: Risankizumab demonstrated consistent and superior efficacy compared with ustekinumab regardless of patient demographics, disease characteristics, or prior biologic exposure.