P46 Long-term efficacy of biologic agents and apremilast in scalp psoriasis: a real-life, cohort study

Abstract Scalp psoriasis affects up to 80% of patients and is the initial manifestation of the disease in ∼25% of cases, with significant psychosocial burden. In our real-life cohort study, we compared the long-term efficacy of the available biologic agents and apremilast from 52 to 78 weeks of treatment between March 2019 and March 2024. Overall, 359 patients from the First Dermatology Department of Thessaloniki, Greece were recruited. Descriptive statistics and ANOVA were used (SPPSS package; statistical significance: P < 0.05). After 1 year of treatment (52 weeks), complete clearance of scalp psoriasis (PSSI 0/1) was achieved or maintained in 96% (24/25) with infliximab, 95.57% (44/46) with guselkumab, 93.94% (31/33) receiving ixekizumab, 93.10% (27/29) with ustekinumab, 93.94% (31/33) with secukinumab, 92.59% (25/27) with certolizumab pegol, 91.83% (45/49) of patients receiving risankizumab, 90.32% (28/31) with brodalumab, 86.21% (25/29) with apremilast, 86.21% (25/29) with etanercept, and 85.71% (24/28) with adalimumab. At 62 weeks, biological agents and apremilast maintained their efficacy: 92.0% (23/25) with infliximab; 97.83% (45/46) with guselkumab; 96.97% (32/33) receiving ixekizumab; 89.66% (26/29) with ustekinumab; 96.97% (32/33) with secukinumab; 88.89% (24/27) with certolizumab pegol, 93.88% (45/49) of patients receiving risankizumab, 96.77% (30/31) with brodalumab, 93.10% (25/29) with apremilast, 82.76% (24/29) with etanercept, and 85.71% (24/28) with adalimumab. Finally, at 78 weeks, clearance rates were maintained at high levels: 88.0% (22/25) with infliximab, 95.65% (44/46) with guselkumab, 100.00% (33/33) receiving ixekizumab, 93.10% (27/29) with ustekinumab, 93.94% (31/33) with secukinumab, 85.19% (23/27) with certolizumab pegol, 97.96% (48/49) of patients receiving risankizumab, 93.55% (29/31) with brodalumab, 86.21% (25/29) with apremilast, 89.65% (26/29) with etanercept, 92.86% (26/28) with adalimumab. No treatment among the agents demonstrated statistically significant superiority at any time point after 52 weeks of therapy (P < 0.05). From Week 52 to Week 78, we found that ∼90% of patients responded to the treatment, thus confirming the long-term efficacy of biological agents and apremilast. At 78 weeks, all treatments could maintain clinical improvement in all patients. Indeed, the proportion of patients achieving PSSI 0/1—even with initially less effective drugs—increased progressively achieving complete clearance or near-complete clearance in 86.21% of patients at Week 78. This study, therefore, confirms what has been previously reported in the literature regarding the sustained efficacy of anti-IL17 and anti-IL23, but also the sustained efficacy, albeit slower than the other classes of biological agents, of anti-TNFα agents and apremilast.