Predictors of Efficacy Maintenance After Vunakizumab Discontinuation in Patients With Moderate-to-Severe Plaque Psoriasis: A Post Hoc Analysis of a Randomized Controlled Trial.
Xiaoling Yu, Yang Li, Xiaoyu Qiu et al.
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In 30 seconds
This post hoc analysis of a phase III randomized controlled trial examined predictors of maintained response after vunakizumab discontinuation in 291 patients with moderate-to-severe plaque psoriasis who had achieved PASI 100 at Week 52. After 20 weeks off treatment, 72.5% maintained PASI 90 and 44.7% maintained PASI 100. In multivariable analyses, treatment interruption was associated with lower odds of maintaining either response; higher BMI and longer psoriasis duration were also associated with lower odds of maintaining PASI 100 and PASI 90, respectively. The investigators developed prediction nomograms with good calibration.
Key findings
- After 20 weeks without vunakizumab, 72.5% maintained PASI 90 and 44.7% maintained PASI 100.
- Treatment interruption was associated with lower odds of PASI 100 maintenance (OR = 0.550, p = 0.020) and PASI 90 maintenance (OR = 0.257, p < 0.001).
- Higher BMI was associated with lower odds of PASI 100 maintenance (OR = 0.922, p = 0.024); longer psoriasis duration was associated with lower odds of PASI 90 maintenance (OR = 0.972, p = 0.049).
- Two nomograms based on multivariable models showed good calibration for predicting PASI 90 and PASI 100 maintenance.
Why it matters
Response persistence after biologic withdrawal varies, even among patients who reach complete skin clearance. These findings identify clinical factors associated with maintaining response over the 20-week discontinuation period and provide estimates that may help frame discussions about treatment interruption. The results are specific to this selected trial population and do not establish that changing treatment based on these predictors improves outcomes.
What to keep in mind
This was a post hoc analysis restricted to trial participants who achieved PASI 100 at Week 52; follow-up after discontinuation was 20 weeks.