Effect of Ixekizumab Treatment on Work Productivity for Patients With Moderate-to-Severe Plaque Psoriasis
Authors: April W. Armstrong, Charles W. Lynde, Sandy R. McBride, Mona Ståhle, Emily Edson-Heredia, Baojin Zhu, David Amato, Enkeleida Nikaï, Fan Emily Yang, Kenneth B. Gordon
Journal: JAMA Dermatology (2016)

<h3>Importance</h3> Therapies that reduce psoriasis symptoms may improve work productivity. <h3>Objective</h3> To assess the effect of ixekizumab therapy on work productivity, measured by the Work Productivity and Activity Impairment–Psoriasis (WPAI-PSO). <h3>Design, Setting, and Participants</h3> Three multicenter, randomized double-blind phase 3 trials conducted during the following periods: December 2011 through August 2014 (UNCOVER-1), May 2012 through April 2015 (UNCOVER-2), and August 2012 through July 2014 (UNCOVER-3). Adult outpatients with moderate-to-severe chronic plaque psoriasis were included. <h3>Interventions</h3> In UNCOVER-1, patients were randomized 1:1:1 to subcutaneous placebo or 80 mg ixekizumab every 2 weeks (Q2W) or every 4 weeks (Q4W) for 12 weeks; UNCOVER-2 and UNCOVER-3 also had an etanercept arm (50 mg twice weekly). Maintenance of initial ixekizumab response was evaluated in UNCOVER-1 and UNCOVER-2 during a randomized withdrawal period following week 12 through week 60. The WPAI-PSO questionnaire was administered at baseline and week 12 for all patients and at weeks 24, 36, 52, and 60 for patients in UNCOVER-1 and UNCOVER-2. <h3>Main Outcomes and Measures</h3> Change in work productivity from baseline as measured by WPAI-PSO scores. <h3>Results</h3> Across trials, 5101 patients consented; 3866 were randomized (mean [SD] age, UNCOVER-1, 45.7 [12.9] y, 68.1% male; UNCOVER-2: 45.0 [13.0] y, 67.1% male; UNCOVER-3: 45.8 [13.1] y, 68.2% male). At week 12 in UNCOVER-1, the ixekizumab Q4W and ixekizumab Q2W groups showed significantly greater improvements in WPAI-PSO scores (least squares mean change from baseline [SE]) relative to placebo: absenteeism (–3.5 [0.87],<i>P</i> &lt; .001; –2.6 [0.84],<i>P</i> = .003, respectively, vs 0.2 [0.88]), presenteeism (–18.8 [1.28],<i>P</i> &lt; .001; –18.3 [1.24],<i>P</i> &lt; .001, vs 0.5 [1.30]), work productivity loss (–20.6 [1.38],<i>P</i> &lt; .001; –19.8 [1.33],<i>P</i> &lt; .001, vs –0.8 [1.40]), and activity impairment (–24.5 [1.18],<i>P</i> &lt; .001; –25.2 [1.15],<i>P</i> &lt; .001, vs 0.8 [1.18]). Similar results were obtained for UNCOVER-2 and UNCOVER-3, with the exception of absenteeism with ixekizumab Q4W in UNCOVER-2. Additionally, ixekizumab-treated patients showed significantly greater improvements in WPAI-PSO scores vs etanercept-treated patients: UNCOVER-2: presenteeism, work productivity loss, activity impairment (<i>P</i> &lt; .001 both doses), UNCOVER-3: activity impairment (ie, regular activities outside of work) (ixekizumab Q2W;<i>P</i> = .009). Improvements in WPAI-PSO scores at week 12 were sustained to at least week 60. <h3>Conclusions and Relevance</h3> Ixekizumab-treated patients reported short- and long-term improvements in work productivity, which could lead to reduced productivity-related cost burden in patients with psoriasis. <h3>Trial Registration</h3> clinicaltrials.gov Identifiers:NCT01474512,NCT01597245,NCT01646177