Ixekizumab Efficacious and Cost Effective for Biologic Treatment of PsO

New findings from a cohort study have found that ixekizumab may offer the best intersection of biologic efficacy and cost-effectiveness in people with psoriasis (PsO), although methotrexate and phototherapy remain the most cost-effective treatment options.1

“Effective and cost-effective management strategies for psoriasis are crucial for clinical decision-making. In the management of PsO, evidence concerning the effectiveness and cost-effectiveness of therapies from both clinicians’ and patients’ perspectives is vital for clinical decision-making,” lead investigator Ning Yu, Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China, and colleagues wrote.1

Yu and colleagues collected data from the observational, multicenter Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH) prospective registry to compare the effectiveness and cost-effectiveness of acitretin, methotrexate, phototherapy, and biologics including adalimumab, ustekinumab, guselkumab, secukinumab, and ixekizumab for chronic plaque PsO.

The efficacy data they collected included both clinician- and patient-reported outcomes to comprehensively evaluate treatment impacts including both clinical disease improvements and patient-perceived quality of life enhancements. These measures included the proportions of patients achieving 75% improvement in Psoriasis Area and Severity Index (PASI 75), PASI 90, PASI 100, minimally important difference in Dermatology Life Quality Index (DLQI MID), DLQI 0/1, and Patient Global Assessment (PtGA) MID at 12 weeks. In terms of cost efficacy, investigators computed the number needed to treat (NNT) and incremental cost per responder (ICPR) relative to acitretin.

The cohort study included a total of 1916 patients with chronic plaque PsO that were receiving acitretin (n = 240), methotrexate (n = 459), phototherapy (n = 391), adalimumab (n = 64), ustekinumab (n = 164), guselkumab (n = 97), secukinumab (n = 298), and ixekizumab (n = 203).1

Yu and colleagues found that at 12 weeks, patients on methotrexate (adjusted relative risk [RR], 2.03 [95% CI, 1.66–2.48]), phototherapy (RR, 2.01 [95% CI, 1.64–2.46]), adalimumab (RR, 2.22 [95% CI, 1.66–2.96]), ustekinumab (RR, 2.86 [95% CI, 2.27–3.62]), guselkumab (RR, 3.34 [95% CI, 2.54–4.38]), secukinumab (RR, 3.38 [95% CI, 2.74–4.16]), and ixekizumab (RR, 3.59 [95% CI, 2.88–4.47]) were more likely to achieve PASI 75 compared to those on acitretin. These findings were further corroborated in analyses for PASI 90, PASI 100, DLQI MID, DLQI 0/1, and PtGA MID.1

Patients on ixekizumab had the lowest NNT for achieving PASI 75 (1.78, 95% CI 1.33–2.45), followed by secukinumab (1.94, 95% CI 1.46–2.64) and guselkumab (1.97, 95% CI 1.36–2.98), with no statistical difference among them. For PASI 90, ixekizumab (2.74, 95% CI 1.37–5.78) and guselkumab (3.37, 95% CI 1.68–7.29) exhibited the lowest NNTs, while for PASI 100, ixekizumab (2.84, 95% CI 1.10–7.83) and secukinumab (3.73, 95% CI 1.46–10.39) demonstrated optimal outcomes.

While biologics led the way in efficacy, methotrexate and phototherapy demonstrated numerically lower ICPR values compared to other treatments. For the PASI 75 endpoint, the ICPR for phototherapy was calculated at $1731. For biologics, the respective figures were $17,555 for adalimumab, $6963 for ustekinumab, $8361 for guselkumab, $7130 for secukinumab, and $4801 for ixekizumab. Since methotrexate incurs a lower annual cost than acitretin, its corresponding ICPR was noted as $0. Overall, the findings support previous reserach identifying ixekizumab as a cost-effective biologic for PsO treatment.2

"Going beyond traditional RCTs and meta-analyses, these findings significantly inform clinical decision-making, aiding healthcare providers and patients in making informed treatment choices with valuable cost-effectiveness insights. The need for future research is evident: longitudinal studies are essential to compare costs against long-term clinical outcomes in real-world settings. Lastly, given the evolving landscape of psoriasis treatments, with changes in pricing and the emergence of novel therapies like apremilast and deucravacitinib, ongoing updates to these findings are imperative in future studies," Yu and colleagues concluded.1

REFERENCES

1. Yu N, Wang Y, Cui L, et al. Comprehensive analysis of effectiveness and cost‐effectiveness of treatments for psoriasis integrating clinician‐ and patient‐reported outcomes: A cohort study from speech. Dermatologic Therapy. 2025;2025(1). doi:10.1155/dth/9464860

2. Schweikert B, Malmberg C, Núñez M, Dilla T, Sapin C, Hartz S. Cost-effectiveness analysis of ixekizumab versus secukinumab in patients with psoriatic arthritis and concomitant moderate-to-severe psoriasis in Spain. BMJ Open. 2020;10(8):e032552. doi:https://doi.org/10.1136/bmjopen-2019-032552