P156 Real-world outcomes of secukinumab dose escalation in patients with plaque psoriasis weighing > 90 kg

Abstract

Secukinumab, an interleukin-17A inhibitor, is recommended by NICE for treatment of psoriasis at 300 mg every 4 weeks. Body mass index impacts the efficacy of anti-interleukin medications more than other biologics. Evidence suggests that patients weighing > 90 kg with suboptimal control may benefit from 2-weekly dosing of secukinumab. However, real-world data on the effect of its dose escalation in higher body mass index groups remain limited. This audit assesses treatment outcomes following dose escalation of secukinumab in real-world psoriasis care across a multisite hospital trust. A retrospective audit was conducted of all patients receiving secukinumab for plaque psoriasis at a multisite trust (n = 35, January 2025). Data collected included demographics, weight, Psoriasis Area and Severity Index (PASI) scores, and clinician- and patient-reported disease control. Patients were classified as ‘well controlled’ or ‘poorly controlled’ based on objective (PASI) and subjective assessments, per the NICE guidelines. Those weighing > 90 kg with suboptimal response to monthly dosing were evaluated for eligibility and outcomes following escalation to 2-weekly dosing. The results were re-evaluated 12 months later to assess the lasting effect of dose escalation. Of 35 patients receiving secukinumab, 26 achieved good control on standard 4-weekly dosing. Nine had inadequate control; seven weighed > 90 kg and met the criteria for dose escalation. All seven were offered 2-weekly dosing; six switched and one declined. Four of six achieved marked improvement, while two showed minimal improvement. One patient weighing < 90 kg with poor control on monthly dosing was also escalated and showed excellent response. Patients with psoriasis weighing > 90 kg may experience suboptimal control on standard secukinumab dosing. This audit showed that a majority of patients across the trust who met the criteria and underwent dose escalation achieved meaningful clinical improvement, supporting the real-world benefit of 2-weekly secukinumab in this subgroup.