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The IL-17 inhibitor secukinumab (Cosentyx) may be more effective against mild-to-moderate psoriasis than moderate-to-severe psoriasis, according to recent research findings published in the .

Moderate-to-severe psoriasis is generally defined as psoriasis that covers ≥10% body surface area and a score of 12 or greater on the Psoriasis Area and Severity Index (PASI). Mild-to-moderate psoriasis constitutes 82% of all psoriasis cases and can significantly impact quality of life.

To date, the FDA has only for use in moderate-to-severe psoriasis.

By week 12 of the randomized controlled trial, patients with mild-to-moderate psoriasis (defined as a PASI of 6-12 and less than 10% body surface area coverage) who were treated with secukinumab saw greater rates of PASI75 (72.7% in secukinumab vs 0% in placebo; P<.005) and PASI90 (63.6% in secukinumab vs 0% in placebo; P<.005) compared with placebo. All participants with mild-to-moderate psoriasis achieved a PASI75 after 16 weeks, with improvements beginning as early as 2 weeks.

Dermatologist and researcher with the University of California Davis School of Medicine, Jaehwan Kim, MD, PhD served as the report's first author. He recently discussed the study and its findings with the Reading Room. The exchange has been edited for length and clarity.

What was the impetus for this study?

Kim: Right now, all biologics for psoriasis are approved by the FDA for only moderate to severe psoriasis. They are not approved for mild psoriasis. And the line between mild and moderate psoriasis is arbitrary, in my opinion.

I believe that the current situation is problematic, because many patients with psoriasis have localized rashes that cover less than 10% of the body surface, but symptoms can still be severe. For example, rash limited to a patient's scalp or hands could really cause suffering, yet their psoriasis is still considered "mild" based on FDA indications and thus cannot be treated with biologics.

So our research question was: are biologics as effective for psoriasis treatment when the psoriasis is mild? Specifically, since the expression of immune regulatory genes is high in mild psoriasis, we hypothesized that treatment response and disease remission after IL-17a inhibition differs in mild psoriasis compared with severe psoriasis.

What was your key conclusion?

Kim: The results were quite straightforward: Compared with placebo, secukinumab is effective for mild psoriasis. Even though we did not directly compare mild and severe psoriasis, the data indicate that it might be more effective in mild psoriasis.

What are your suggestions for clinicians who treat patients with psoriasis, based on these findings?

Kim: The study supports the current FDA guidelines for the use of biologics for moderate-to-severe psoriasis, but also might challenge guidelines for mild-to-moderate psoriasis.

There might be a way to use biologics for patients even if they have less than 10% coverage of their body surface area. With those patients in mind, I believe we need to understand more about the effects of biologics in mild psoriasis.

What does the future hold for this topic?

Kim: Our study supports the increasing trend to explore systemic treatments for mild-to-moderate psoriasis.

I'm currently doing a study on gene expression in patients with mild psoriasis. Since many biologics are newer than the FDA guidelines, we need new data. These drugs are very effective and safe but also very expensive, so also in the decision-making process there should be more information about patients and how they feel about all these impacts.

Key points:

• Study finds secukinumab effective in people with mild psoriasis.
• FDA has not approved a biologic for mild psoriasis.
• More studies needed into therapeutic options and impacts for people with mild psoriasis.