Low Radiographic Progression in Psoriatic Arthritis Sustained with Secukinumab

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Secukinumab (Cosentyx, Novartis) provided sustained low rates of radiographic progression through 52 weeks in patients with active psoriatic arthritis, say researchers writing in Rheumatology this month.

Approximately 50 percent of psoriatic arthritis patients are diagnosed with erosive joint destruction within two years of disease onset. Structural damage and radiographic disease progression are associated with the presence of IL-17A-producing immune cells at the inflamed joints. Secukinumab, a human monoclonal IgG1κ antibody that directly inhibits IL-17A, has shown rapid and sustained efficacy in patients with psoriatic arthritis in the phase three FUTURE studies. In the FUTURE 1 study, secukinumab 150 mg showed sustained clinical responses with a low rate of radiographic progression over three years. In FUTURE 5, secukinumab 300 mg and 150 mg subcutaneous dosing regimens lowered the rate of radiographic disease progression versus placebo at week 24. Secukinumab 300 mg and 150 mg subcutaneous doses have been approved for treatment of psoriatic arthritis.

“We present the effects of secukinumab 300 and 150 mg dosing regimens on radiographic disease progression through 52 weeks from the FUTURE 5 study,” wrote the authors, led by Désirée van der Heijde, M.D., Ph.D., Leiden University Medical Center in The Netherlands.

In the study, 996 patients with active psoriatic arthritis,  stratified by prior anti-TNF use, were randomized to subcutaneous secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks one, two and three and every four weeks starting at week four. Radiographic progression was assessed by change in van der Heijde-modified total Sharp score (vdH-mTSS).  Of the participants, 862 (86.8 percent) remained in the study for 52 weeks. At week 52, the proportion of patients without radiographic progression (change vdH-mTSS ⩽0.5) was 91.8 percent, 85.2 percent and 87.2 percent in 300 mg, 150 mg and 150 mg no load groups, respectively.

“Secukinumab 300 and 150 mg with or without subcutaneous loading regimen provided sustained low rates of radiographic progression through 52 weeks of treatment,” the authors wrote. “Low rates of radiographic progression were also observed in secukinumab-treated patients regardless of prior anti-TNF therapy status.”

Sustained improvement was observed in secukinumab-treated patients across all efficacy endpoints including disease activity and physical function through week 52. The ACR20 response was 68.9 percent, 64.1 percent and 65.6 percent in secukinumab 300 mg, 150 mg and 150 mg no load groups, respectively, at week 52. No new or unexpected safety signals were reported.

“These results extend previous findings confirming sustained low rates of radiographic progression, clinical efficacy and safety of secukinumab for the treatment of patients with active psoriatic arthritis,” the authors wrote.

REFERENCE

Désirée van der Heijde, Philip J Mease, Robert B M Landewé, et al. “Secukinumab provides sustained low rates of radiographic progression in psoriatic arthritis: 52-week results from a phase 3 study, FUTURE 5.” Rheumatology (Oxford). October 5, 2019. https://doi.org/10.1093/rheumatology/kez420