Efficacy and safety of secukinumab in Chinese patients with psoriasis: Update of six-year real-world data and a meta-analysis

To the Editor: Psoriasis, a chronic immune-mediated disorder affecting 0.09–11.4% of population globally, imposes profound physical, psychological, and socioeconomic burdens on patients. Conventional therapies, including phototherapy and systemic agents, often yield poor long-term efficacy due to inadequate targeting of disease pathophysiology and tolerability concerns.[1] Recent advances in understanding interleukin-17A (IL-17A) as the central cytokine driving psoriatic inflammation have revolutionized treatment, positioning IL-17 inhibitors as cornerstone therapies for moderate-to-severe disease. Secukinumab, a fully human monoclonal antibody neutralizing IL-17A, demonstrated robust efficacy in global clinical trials, achieving sustained skin clearance and quality-of-life improvements. Since its 2018 approval in China, secukinumab has been integrated into routine clinical practice.[2] Despite accumulating real-world evidence (RWE) from Western registries, comprehensive analyses in Chinese populations remain sparse. Existing studies are limited by small sample sizes, short follow-up durations, or fragmented safety assessments, leaving critical gaps in optimizing therapeutic strategies. Notably, longitudinal data on durability of response, late-emerging adverse events, and subgroup-specific outcomes are urgently needed to inform clinical decision-making.[3] This meta-analysis synthesizes RWE from 6583 Chinese patients to address these knowledge gaps. By evaluating temporal trends in efficacy metrics–including Psoriasis Area and Severity Index (PASI) responses and Dermatology Life Quality Index (DLQI) improvements, we aimed to elucidate the real-world performance of secukinumab. Concurrently, systematic safety profiling and exploratory analyses of demographic modulators provide actionable insights for personalized care. A systematic review of real-world studies was conducted following PRISMA guidelines. PubMed, Embase, Cochrane Library, CNKI, and Chinese regional databases (Wanfang, VIP) were queried from July 2018 to July 2024 using keywords: secukinumab, psoriasis, China, and real-world evidence. Observational studies (>10 patients) reporting PASI/DLQI outcomes or safety data in Chinese adults with moderate-to-severe psoriasis treated with secukinumab (≥4 weeks) were eligible. Case reports, reviews, and non-Chinese cohorts were excluded [Supplementary Table 1, https://links.lww.com/CM9/C497]. Two reviewers independently screened titles/abstracts, assessed full texts using the Newcastle-Ottawa Scale (NOS), and extracted data via standardized forms [Supplementary Figures 1 and 2, https://links.lww.com/CM9/C497]. Discrepancies were resolved through consensus or third-party adjudication. Freeman–Tukey double arcsine transformation addressed extreme proportions (e.g., 100% PASI responses). Meta-analyses pooled weighted proportions for efficacy endpoints (PASI 75/90/100, DLQI 0/1, Investigator's Global Assessment [IGA] 0/1) using random-effects models (RevMan 5.4.1; Cochrane Collaboration), with heterogeneity quantified via I2. Exploratory linear regression (GraphPad Prism 9, GraphPad Software, San Diego, CA, USA) evaluated age, body mass index (BMI), smoking, and disease duration as predictors of PASI 90 response at week 12. The meta-analysis synthesized data from 39 real-world studies involving 6583 Chinese patients with psoriasis, including 4200 administered secukinumab [Supplementary Table 2, https://links.lww.com/CM9/C497]. Early efficacy emerged by Week 4, with 47.0% of patients achieving ≥75% improvement in PASI (PASI 75; 95% confidence interval [CI]: 0.42–0.53, n = 2087) and 21.0% attaining ≥90% clearance (PASI 90; 95% CI 0.16–0.26, n = 2121). Response rates escalated by Week 12, reaching 92.0% for PASI 75 (95% CI 0.90–0.94, n = 2175; I2 = 0%) and 73.0% for PASI 90 (95% CI 0.69–0.78, n = 2215; I2 = 67%). Complete disease resolution (PASI 100) increased from 7.0% at Week 4 (95% CI 0.03–0.10, n = 1696) to 40.9% at Week 12 (95% CI 0.34–0.47, n = 2024) and peaked at 65.9% by Week 24 (95% CI 0.55–0.77, n = 499). Sustained efficacy was evident at Week 52, with 92.9% maintaining PASI 75 (95% CI 0.89–0.96, n = 634) and 74.9% achieving PASI 90 (95% CI 0.71–0.79, n = 634), demonstrating minimal heterogeneity (I2 ≤11%) [Supplementary Figure 3, https://links.lww.com/CM9/C497]. Quality-of-life metrics mirrored clinical improvements: 20.0% of patients reported minimal disease impact (DLQI 0/1) at Week 4 (95% CI 0.11–0.29, n = 1283), rising to 62.0% at Week 12 (95% CI 0.48–0.75, n = 1296) and peaking at 71.0% by Week 24 (95% CI 0.51–0.92, n = 650). Investigator-assessed outcomes confirmed these trends, with 85.0% achieving near-complete clearance (IGA 0/1) at Week 12 (95% CI 0.78–0.93, n = 1553) and 88.0% at Week 24 (95% CI 0.79–0.97, n = 836) [Supplementary Figure 4, https://links.lww.com/CM9/C497]. An overall response rate of 97.0% (95% CI 0.95–1.00, n = 1813) was observed across studies, with no heterogeneity (I2 = 0%) [Supplementary Figure 5, https://links.lww.com/CM9/C497]. Safety data from 4200 patients revealed a 7.1% incidence of adverse events (AEs), predominantly mild to moderate [Supplementary Table 3, https://links.lww.com/CM9/C497]. Upper respiratory infections (1.7%), pruritus (0.9%), and nonspecific infections (0.8%) were most common. Severe AEs necessitating discontinuation occurred in 0.8% of cases. Linear regression analysis identified age as a significant predictor of Week 12 PASI 90 response (β = −0.8% per year; 95% CI: −1.5% to −0.1%; P = 0.0257), exemplified by a 24.0% efficacy gap between 20-year-old (94% probability) and 50-year-old patients (70.0%). BMI (β = −0.3% per kg/m2; P = 0.323), disease duration (β = −0.05% per year; P = 0.804), and smoking (smokers vs. nonsmokers: 68.0% vs. 74.0%; P = 0.064) showed no statistically significant associations, though smoking exhibited a marginal negative trend [Supplementary Figure 6, https://links.lww.com/CM9/C497]. Combination therapy with phototherapy or topical agents enhanced early responses, yielding Week 24 PASI 100 rates of 72.0% (95% CI 0.67–0.88, n = 254) compared to 64.1% (95% CI 0.52–0.79, n = 245) for monotherapy. However, absolute efficacy differences diminished over time, with Week 52 PASI 75/90 rates overlapping between regimens (93.0% vs. 91.0%; 75.0% vs. 73.0%) [Supplementary Figure 7, https://links.lww.com/CM9/C497]. This meta-analysis confirms secukinumab's robust efficacy and safety in Chinese patients with psoriasis, with Week 12 PASI 75/90 rates (92.0%/73.0%) surpassing Western real-world cohorts (72.0%/50.0%). Notably, early superiority (Week 24 PASI 100: 66.0% vs. 46.0%) highlights potential ethnic distinctions in IL-17 pathway dynamics or treatment adherence. The inverse age-efficacy relationship (−0.8% PASI 90/year) mirrors global trends, suggesting biological aging may dampen IL-17A blockade response. The low AE incidence (7.1%) reinforces secukinumab's suitability for long-term use.[4] Despite high short-term efficacy, Week 52 PASI 100 decline (38.0%) signals a need for dose optimization or combinatorial strategies in later phases—a phenomenon also observed in European registries. Limitations include heterogeneous follow-up durations and potential regional prescription biases.[5] In conclusion, secukinumab demonstrates rapid, durable efficacy and favorable tolerability in Chinese patients, with age serving as a key modifier of treatment response. These findings underscore the importance of ethnically tailored real-world evaluations to optimize global psoriasis management. Acknowledgments We thank Prof. Jan Peter Dutz, from the Department of Dermatology and Skin Science, University of British Columbia, Canada, for his critical comments. Conflicts of interest None.