Extension of ustekinumab maintenance dosing interval in moderate-to-severe psoriasis: results of a Phase 3b, randomized, double-blinded, active-controlled, multicenter study (PSTELLAR)

Abstract

Background

Phase 3 studies showed some patients maintained response for ≥6 months post-ustekinumab discontinuation.

Objectives

To assess clinical responses with extended ustekinumab maintenance dosing intervals.

Methods

Adults with moderate-to-severe plaque psoriasis received ustekinumab (45mg/90mg for weight ≤100 kg/>100 kg) at Week0, Week4, Week16 during open-label treatment. Patients achieving a Week 28 Physician's Global Assessment score of cleared/minimal (PGA=0/1) were randomized 1:4 to Group1 (approved every-12-weeks [q12wk] maintenance) or Group2 (q12-24wk response-based dosing determined by time–to-loss-of-PGA=0/1). Key endpoints included number of visits with PGA=0/1 (primary endpoint) and ≥75% improvement in Psoriasis Area and Severity Index (PASI75) between Weeks88-112, and PGA/PASI responses between Weeks28-112.

Results

378 patients achieved PGA=0/1 at Week28 and were randomized to Group1 (n=76) or Group2 (n=302). Group1 patients had numerically greater mean numbers of visits with PGA=0/1 than Group2 (4.5 and 4.1, respectively; mean-difference [95%CI]: -0.46 [-1.20; 0.29]) and PASI75 (5.8 and 5.4, respectively; -0.32 [-0.96;0.33]) from Week88-112. A higher proportion of patients in Group1 (55.3%) than Group2 (38.7%) had PGA=0/1 at all seven Week88-112 visits. Maintenance of response was observed with dose-interval extension beyond q12wk (q16wk, q20wk, q24wk) in a subset of patients (28% of patients randomized to Group 2 extended maintenance dosing to q24wks and maintained high levels of response). Extending dosing interval did not affect antibody development or safety.

Conclusions

Efficacy was better maintained among Week28 PGA-responders randomized to continue q12wk ustekinumab versus extending maintenance dosing based on clinical response, although some patients maintained high levels of efficacy with up to q24wk dosing.

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