Brodalumab as a Second-Line Therapy in Psoriasis: Rapid Response and Unique Mechanism of Action After Biologic Failure

This narrative review evaluates the clinical evidence supporting brodalumab as a second-line therapy against moderate-to-severe plaque psoriasis in adults who have experienced prior systemic treatment failure. Despite advances in biologic therapy, treatment failure remains a substantial challenge, with patients often discontinuing initial biologic treatment owing to inadequate response. Here, we analyzed data from clinical trials, real-world studies, and observational research examining brodalumab's efficacy in treatment-experienced populations. Unlike other biologics that target specific interleukin 17 (IL-17) cytokines, brodalumab blocks the IL-17 receptor A and prevents signaling from multiple IL-17 family members, potentially explaining its effectiveness in treatment-resistant cases. The evidence presented here demonstrates rapid Psoriasis Area and Severity Index response rates, as well as durable efficacy of brodalumab in patients after a failed treatment with previous biologic therapies. This narrative review synthesizes the current evidence base for brodalumab's role specifically in the second-line setting, providing clinicians with a comprehensive assessment of its efficacy in treatment-resistant psoriasis.