Secukinumab Shows Superior Psychological Outcomes to Ixekizumab in Psoriasis

While secukinumab and ixekizumab show comparable clinical efficacy in treating moderate-to-severe psoriasis, new findings suggest secukinumab treatment may result in superior psychological outcomes.1

These findings on such outcomes and the use of these 2 drugs resulted from new research authored by Yuling Shi, MD, PhD, from the department of dermatology at Tongji University School of Medicine’s Shanghai Skin Disease Hospital. Shi et al noted that while secukinumab and ixekizumab, both interleukin (IL)-17A inhibitors, have been assessed among patients with psoriasis, their comparative efficacy had been underexplored.2

“By assessing both physician-reported outcomes (including PASI and PGA) and PROs (including HADS, DLQI, and PtGA), this study seeks to offer a comprehensive understanding of the relative advantages of these two biologics in psoriasis management, ensuring that patients receive appropriate and effective treatment based on their individual situation,” Shi and coauthors wrote.1

Study Design and Findings

The investigative team's primary objective was to assess and compare the effectiveness of secukinumab and ixekizumab among adults in China with moderate-to-severe psoriasis. Shi and colleagues would focus specifically on both clinician-reported and patient-reported outcomes (PROs). They drew the necessary data from the Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH)—a prospective, multicenter, observational registry.

Those deemed eligible to be included in this analysis were adults who had a Psoriasis Area and Severity Index (PASI) score of ≥10 and a body surface area (BSA) of ≥10% for at least 6 months and were treated with either secukinumab or ixekizumab after implementing standard dosing regimens without modifications to dose or interval. The investigative team excluded subjects if they lacked follow-up information, had missing baseline Hospital Anxiety and Depression Scale (HADS) data, showed other significant psychiatric conditions, or were taking medications that could impact the team's results.

The investigators would evaluate psoriasis severity was via physician-reported measures such as the PASI and Physician’s Global Assessment (PGA). They would also look at PROs, including the Patient Global Assessment (PtGA), Dermatology Life Quality Index (DLQI), and HADS. They assessed baseline data, including looking at clinical factors (disease duration, body mass index, previous biologic exposure, and comorbidities such as hypertension, obesity, or psoriatic arthritis), demographic details, and lifestyle characteristics such as smoking and alcohol use.

Shi and coauthors looked at several different efficacy endpoints at the 12-week mark, including looking into the proportions of participants attaining ≥75% improvement in PASI (PASI 75), PASI 90, PGA 0/1 (indicating clear or almost clear skin), a DLQI 0/1 (no or minimal impact on quality of life), PtGA 0/1 (cured or almost cured), and complete resolution of anxiety (HADS-A = 0) or depression (HADS-D = 0).

By the 12-week mark, the investigative team concluded that comparable performances by secukinumab and ixekizumab were observed in PASI 75, PASI 90, and PGA 0/1 response rates (P > .05). However, they did highlight that secukinumab showed significantly greater improvement in participants' psychological outcomes. Specifically, the team found 49% of secukinumab-treated subjects, versus 28% of subjects on ixekizumab, attained HADS-A = 0, and 31% versus 19% achieved HADS-D = 0 (P < .05 for both).

Shi et al further determined that the least squares mean reductions from baseline in participants' HADS-A and HADS-D scores were more substantial among those treated with secukinumab therapy. Subgroup analyses within the secukinumab cohort showed no significant differences in patients' likelihood of achieving HADS-A = 0 or HADS-D = 0 across different clinical or demographic characteristics.

“The study emphasizes that mental health should be included in the routine care of psoriasis patients, with appropriate and effective treatment tailored to the individual patient’s condition,” the investigators concluded.1 “Further research is needed to elucidate the mechanisms underlying these effects and to explore their long-term implications for people with psoriasis.”

References

1. Dai M, Jiang Y, Shi Y, et al. Comparative Efficacy of Secukinumab and Ixekizumab on Clinical and Psychological Outcomes in Psoriasis Patients: A Multicenter Prospective Cohort Study. Dermatologic Therapy, 2025, 7025415, 8 pages, 2025. https://doi.org/10.1155/dth/7025415.

2. Torres T, Puig L, Chiricozzi A, et al. Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study. Am J Clin Dermatol. 2021 Jul;22(4):567-579. doi: 10.1007/s40257-021-00598-4. Epub 2021 Mar 30. PMID: 33786754.