Psoriasis patients with overweight, obesity may need higher vunakizumab dosage

In the treatment of moderate-to-severe psoriasis, patients with overweight or obesity appear to have a diminished response to vunakizumab compared with those who have lower BMIs, according to a post hoc subgroup analysis of a phase III trial.

Response rates to vunakizumab 240 mg at the 12-week follow-up, decreased as BMI increased, reported study author Prof Linfeng Li from Beijing Friendship Hospital, Beijing, China.

Li noted that vunakizumab was administered every 2 weeks for three doses during the induction phase, followed by a maintenance dose every 4 weeks through week 52.

At week 12, Psoriasis Area and Severity Index (PASI) 90 response was seen in 84.9 percent of patients with normal weight or lower (BMI <24 kg/m²), 77.6 percent of those with overweight (BMI 24–27.9 kg/m²), and 66.7 percent of those with obesity (BMI ≥28 kg/m²). The median time to achieve PASI 90 was longest in the obesity group at 71.5 days as opposed to 57 days in the normal weight or under group and 58 days in the overweight group. [EADV 2024, abstract 3686]

Results for the Static Physician's Global Assessment (sPGA) 0/1 response followed a similar trend, with rates of 83.2 percent in the normal weight or under group, 76.0 percent in the overweight group, and 61.6 percent in the obesity group. The same held true for PASI 75 (97.2 percent, 95.1 percent, and 85.9 percent, respectively), PASI 100 (45.8 percent, 39.9 percent, and 23.2 percent, respectively) and sPGA 0 (46.9 percent, 42.6 percent, and 24.2 percent, respectively) responses.

Compared with normal weight or under, obesity was associated with greater odds of having lower response for PASI 90 (odds ratio [OR], 2.8, 95 percent confidence interval [CI], 1.6–5.0), PASI 75 (OR, 5.7, 95 percent CI, 2.1–15.8), PASI 100 (OR, 2.8, 95 percent CI, 1.6–4.8), and sPGA 0/1 (OR, 3.1, 95 percent CI, 1.8–5.4).

These findings were further confirmed in analyses of the longer-term 52-week data, serum vunakizumab concentrations, and subgroup defined by body weight (<90 vs ≥90 kg), according to Li.

As for safety, treatment-emergent adverse events occurred with similar frequency across BMI groups, he added.

In conclusion, Li emphasized that higher BMI and greater body weight negatively influence response rates to vunakizumab, which persist throughout the 52-week treatment period.

“The observed decrease in vunakizumab concentration with increasing BMI suggests that standard dosing may be suboptimal for patients with overweight or obesity. Adjusting the dosage based on BMI and body weight could potentially enhance efficacy and optimize patient outcomes,” he said.

The analysis included 461 patients (mean age 41.7 years, 76.4 percent male, mean Body Surface Area 34.45 percent, mean PASI score 22.23) with moderate-to-severe psoriasis who received vunakizumab. Of these, 179 patients were in the normal weight or below group, 183 were in the overweight group, and 99 were in the obese group.