Reviews/Psoriasis Psoriatic Arthritis/Secukinumab pooled PASI 90 response
Pso Il17 · PSA-IL17-03 · v2
Borderline: within 4 points of the Likely/Uncertain boundary, so a re-grade could land either side.
The evidence looks at how often secukinumab clears 90% of a patient's psoriasis, a measure called PASI 90. In tightly controlled trials the drug reached this mark in more patients than the claim states, from about two-thirds to nearly four-fifths [1][2][5][9]. In everyday clinical practice the figures were lower, around 46 to 50% [7][8], and in studies enriched for heavier or obese patients they sat close to 55 to 60% [3][4]. The claimed figure of about 60% sits in the middle of this wide spread and matches one obesity-enriched study almost exactly [4]. The panel judged the claim well supported in direction and rough magnitude but imprecise, because the true rate depends heavily on which patients, which dose and which timepoint are considered.
Nine independent primary studies report absolute secukinumab PASI 90 rates in moderate-to-severe plaque psoriasis. Standard 300 mg RCT settings run high: 79.0% at week 16 in CLEAR [1], 66.5% at week 12 rising to 76.6% at week 16 in CLARITY [2], 75.6% at week 52 by autoinjector in MATURE [5], and 70% at week 48 in the ECLIPSE comparator arm [9]. Weight- and obesity-enriched cohorts sit near the claim, with 55.5% (Q4W) in heavier patients [3] and 55.8-59.6% in ObePso-S [4]. Real-world retrospective cohorts fall below, at 46% [7] and 50% [8]. The ~60% figure is bracketed by, but not centred on, this spread. The contested point: The evidence divides on whether ~60% is the right central estimate or an underestimate: controlled 300 mg RCTs [1][2][5][9] cluster at 66-79%, while real-world cohorts [7][8] cluster at 46-50%. The figures closest to 60% come from weight- and obesity-enriched studies [3][4], not an unselected population, so no single setting cleanly supports the claimed value.
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One reviewer's only job is to attack the finding. The challenges below were weighed before the grade was set.
'Approximately 60%' is anchored to no defined timepoint or dose; corpus figures span week 12 to week 52 across Q2W, Q4W, weight-based and autoinjector regimens, leaving the claim under-specified.
Standard 300 mg pivotal RCTs [1] 79%, [2] 66.5-76.6%, [5] 75.6%, [9] 70% all exceed 60%, so the corpus arguably supports ~70%+ in controlled settings and the claim understates on-label performance.
Where it remains uncertain. The ~60% claim matches only the obesity-enriched ObePso-S figures [4] and understates on-label pivotal RCT performance [1][2][5][9] while overstating real-world effectiveness [7][8].
Aleatory
Reported PASI 90 rates vary widely across patient populations, from 46% [7] to 79% [1], reflecting genuine variability in who responds.
Epistemic
The corpus offers no clean absolute PASI 90 rate for a general moderate-to-severe population at a single defined 300 mg dose and timepoint; the nearest figures [3][4] are weight- or obesity-enriched.
Inferential
Several rates are secukinumab arms of head-to-head trials [1][2][9] designed to compare drugs, not to estimate an absolute population response, so reading them as population estimates is an inference the designs do not support.
The load-bearing papers from a corpus of 10, each classified by what it does to the claim. Every DOI is taken from the corpus the claim was graded on.
Weight-enriched subgroup; standard Q4W dosing near ~55-60%.
“At week 16, Q2W dosing led to significantly higher PASI 90 responses vs. Q4W [73.2% vs. 55.5%, one-sided P = 0.0003].”
Panel auditInternal validity: high · scope of inference: Secukinumab PASI 90 in patients ≥90 kg comparing two dosing frequencies.Key limitations: weight-restricted subgroup · dose-optimization question, not overall efficacy
Directly supports ~60% (59.6% at week 52) in an obesity-enriched cohort.
“Of patients receiving secukinumab, 55.8% and 59.6% achieved PASI90 at Weeks 12 and 52, respectively.”
Panel auditInternal validity: medium · scope of inference: Secukinumab PASI 90 in the ObePso-S trial population.Key limitations: no sample size in abstract · no statistical test reported
Pivotal RCT PASI 90 of 79.0% — upper end of the range, above the claimed 60%.
“Secukinumab (79.0%) was superior to ustekinumab (57.6%) as assessed by PASI 90 response at week 16 (P < .0001).”
Panel auditInternal validity: high · scope of inference: Secukinumab 300 mg week-16 PASI 90 in trial-eligible moderate-to-severe plaque psoriasis.Key limitations: single timepoint (week 16) reported · trial population, not real-world
3 of 10 papers shown. The full review lists all of them, with the panel’s arbitration →
Claims are graded at each quarterly release, and re-graded between releases only when a pivotal trial lands. Every change is a new version of the claim.
The corpus robustly supports a high PASI 90 response bracketing ~60%, but pivotal RCT figures exceed it and real-world figures fall below it, so the specific estimate is defensible but imprecise rather than established.
Release 2026-q4 re-graded every claim from its corpus under protocol v0.19. An earlier release's grade is shown for the record; it came from an earlier protocol and is not a movement.
Assumptions that carry weight but are not themselves established.
The panel records the gap that would most move the claim, and the study that would close it.
No general-population fixed-dose fixed-timepoint estimate. The claim asserts a single ~60% rate but the corpus lacks an unselected-population figure at one defined 300 mg dose and timepoint, leaving the central estimate unpinned. The panel rates this the highest-importance open gap for the claim, and names the study design that would close it: A pre-registered pooled analysis or registry cohort reporting secukinumab 300 mg PASI 90 in an unselected moderate-to-severe population at a single fixed timepoint (e.g. week 16).
Open question: What is secukinumab's PASI 90 rate in an unselected moderate-to-severe population at a single fixed on-label dose and timepoint? Why it is still open: Every absolute figure in the corpus is either enriched [3][4], a comparator-arm byproduct [1][2][9], or real-world [7][8]; none is a clean unselected-population estimate.
Priors is a sceptical first reader, not peer review, and not medical advice.
Release 2026-q4 · graded 18 Sep 2026 · protocol v0.19