AFTER vunakizumab discontinuation, many patients with plaque psoriasis maintained PASI 90, but BMI and interruptions predicted relapses.
Vunakizumab Discontinuation Outcomes at 20 Weeks
A post hoc analysis of a Phase III trial evaluated which patients were most likely to sustain skin clearance after stopping biologic therapy. Investigators analyzed 291 adults with moderate-to-severe plaque psoriasis who achieved complete clearance, defined as 100% improvement in Psoriasis Area and Severity Index (PASI) at Week 52, and then discontinued vunakizumab.
Efficacy maintenance was assessed after 20 weeks off treatment using two thresholds: PASI 90 and PASI 100. After discontinuation, 72.5% of patients maintained PASI 90, while 44.7% maintained PASI 100, highlighting a marked drop-off when complete clearance was used as the endpoint.
Predictors of PASI 90 and PASI 100 Maintenance
In multivariable logistic regression, treatment interruption emerged as a consistent predictor of lower maintenance probability across both endpoints. For PASI 100 maintenance, higher body mass index (BMI) was independently associated with reduced odds of maintaining complete clearance (OR=0.922; p=0.024), and treatment interruption was also associated with lower odds (OR=0.550; p=0.020).
For PASI 90 maintenance, longer duration of psoriasis was linked to reduced odds of maintaining response (OR=0.972; p=0.049), and treatment interruption again showed a strong negative association (OR=0.257; p<0.001). Family history of psoriasis and the first time of PASI 100 achievement did not reach statistical significance for PASI 100 maintenance in this analysis.
Risk Tools for Clinical Follow-Up Planning
To support individualized risk estimation, the authors constructed two nomograms based on the multivariable models, one for predicting PASI 90 maintenance and another for predicting PASI 100 maintenance. Both nomograms demonstrated good calibration performance, suggesting potential utility for structuring follow-up intensity and counseling discussions after treatment cessation.
Clinically, these predictors suggest that follow-up after vunakizumab discontinuation may need to be more proactive for patients with higher BMI, longer disease duration, or any treatment interruption history. While the analysis cannot confirm causality, the findings support using baseline and treatment course factors to counsel patients on relapse risk, set expectations around durability of PASI 90 or PASI 100, and plan earlier review if symptoms begin to return.
Reference: Yu X et al. Predictors of efficacy maintenance after vunakizumab discontinuation in patients with moderate-to-severe plaque psoriasis: a post hoc analysis of a randomized controlled trial. Int J Dermatol. 2026;doi: 10.1111/ijd.70329.
