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Real‐life comparison between secukinumab and ixekizumab in the treatment of pustular and erythrodermic psoriasis

Dear Editor, Pustular (PP) and erythrodermic psoriasis (EP) represent two subtypes of psoriasis that need prompt treatment to prevent potentially life-threating complications. Recently, interleukin-17 inhibitors secukinumab and ixekizumab have shown remarkable results in plaque psoriasis and few studies reported good responses to biologics in PP and EP as well. However, real-life studies comparing secukinumab and ixekizumab in the treatment of PP and EP subtypes cannot be found in the literature. To compare safety and efficacy of secukinumab and ixekizumab in PP and EP patients, we conducted a real-life monocentric cohort study, collecting 20 PP and 15 EP patients from the Dermatology clinic of the University of Turin (Table 1). Retrospective enrolment took place between October 2016 and April 2020, with follow-up until March 2021. Disease severity was assessed at baseline by Psoriasis Area Severity Index (PASI). Patients were treated with secukinumab (two 150 mg-injections at weeks 0, 1, 2, 3 and 4, followed by monthly maintenance) or with ixekizumab (two 80 mg-injections, followed by bimonthly maintenance for 12 weeks and subsequent monthly injections). The primary end-point of the study was PASI at week 12, at week 24 and at week 48. In the PP group, the outcomes at 12 weeks showed that ixekizumab is faster than secukinumab in achieving PASI 90, PASI < 3 and PASI 100, yet without achieving statistically significant difference: a PASI 90 response was achieved by 29% of patients treated with secukinumab and 50% of patients treated with ixekizumab, while a PASI 100 response was achieved in the two groups by 29% and 33% of patients respectively. These results were maintained at week 24, showing a higher rate of