This multicenter retrospective study evaluated the real-world long-term effectiveness and safety of secukinumab (300 mg SC every 4 weeks) in 769 adults with moderate-to-severe plaque psoriasis treated continuously for at least 4 years across 15 Italian dermatology units (2017–2025), with follow-up up to 7 years.
PASI 90 rose from 36.0% at week 16 to 90.0% at year 6; PASI 100 rose from 27.4% at week 16 to 80.2% at year 7. Absolute PASI ≤2 reached 95.0% at year 7. Patients with concomitant PsA had significantly higher PASI 100 rates at years 5 (77.9% vs. 69.8%) and 6 (85.7% vs. 71.4%; p ≤ 0.05). Serious AEs led to permanent discontinuation in only 5 patients (3 de novo malignancies, 1 pulmonary embolism, 1 eosinophilic pneumonia).
- **Survivor bias**: only patients on continuous treatment ≥4 years were included; early discontinuers (for inefficacy, AEs, or preference) are excluded, inflating long-term response rates. - **Retrospective, as-observed analysis**: missing data could not be recovered, and progressively smaller cohorts at later time points (n=769 at year 4 down to n=101 at year 7) limit interpretation. - **No formal drug survival analysis or multivariate adjustment**: confounders cannot be excluded, and subgroup findings should be considered exploratory.
In patients who tolerate and respond to secukinumab, skin clearance rates continue to improve over years — not plateau — suggesting strong long-term durability for those who stay on therapy. Cardiometabolic comorbidities and difficult-to-treat areas did not significantly reduce response rates, supporting secukinumab as a durable option regardless of these factors.
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