Secukinumab May Inhibit Structural Damage in Patients With PsA

In patients with active psoriatic arthritis (PsA) treated with secukinumab (Cosentyx; Novartis), sustained low disease activity (LDA)/ remission (REM) was associated with improvements in physical function, health-related quality of life, and inhibition of structural damage progression. This is according to a study published in RMD Open.¹

Laura Coates, MBChB, MRCP, PhD

Credit: University of Oxford

“These analyses provide further insights into the long-term achievement of LDA or REM in patients treated with secukinumab, which is associated with better long-term function and patient reported outcome benefits,” wrote Laura Coates, MBChB, MRCP, PhD, an associate professor at the University of Oxford in the UK, and colleagues. “Moreover, irrespective of achievement of sustained LDA or REM, there was inhibition of structural damage, highlighting the protective effect of secukinumab on radiographic progression in patients with PsA.”

Secukinumab, a human monoclonal antibody that inhibits interleukin-17A (IL-17A), has shown sustained improvement in signs, symptoms, physical function, and improvement of health-related quality of life in patients with PsA over 5 years in the phase 3 FUTURE program. In this retrospective analysis of data from the 2-year FUTURE 5 study, the researchers looked at the proportion of secukinumab-treated patients with active PsA who achieved and sustained LDA or REM, along with the potential benefits and the predictors of achieving long-term sustained LDA/ REM.

In FUTURE 5, patients were categorized according to LDA (minimal disease activity [MDA]/Disease Activity index for Psoriatic Arthritis [DAPSA] LDA+REM) or REM (very LDA/DAPSA REM): not achieving LDA/REM, achieving it once or sustained LDA/REM 3 times or more between 24 weeks and 2 years. A total of 996 patients were randomized into the secukinumab 300 mg, secukinumab 150 mg loading and non-loading, and placebo treatment groups.Of the patients, 21.4% discontinued before or at year 2.

At 2 years, 48% to 81% of patients treated with secukinumab 150 mg or 300 mg were able to achieve sustained LDA irrespective of the outcome measure used, that is, MDA or DAPSA LDA+REM. However, only 19% to 36% of patients were able to achieve sustained REM through 2 years. Compared with LDA/REM achieved once or not at all, numerically greater improvements in physical function and quality of life were seen with sustained LDA/REM. Regardless of achieving sustained LDA/REM, a high proportion of secukinumab-treated patients did not have structural damage progression at 2 years. Patients who achieved a sustained LDA were younger, had a lower baseline body mass index (BMI), along with a reduced tender joint count and PsA pain at week 16.

“These data reinforce the validity of MDA and DAPSA LDA+REM as treatment goals in PsA since their achievement led to clinically meaningful benefits in health-related quality of life and physical function in PsA,” investigators concluded. “Patients who sustain these stringent outcomes tend to be younger, with low BMI and milder disease, which emphasizes the need for early intervention in terms of diagnosis and management of the disease.”

Limitations of the analysis included its post hoc nature, as the study was not primarily designed as a target to treat study and the retrospective analysis of targets. Additionally, there was a lack of a long-term comparator as the placebo-controlled period of the core FUTURE 5 study was only up to week 24.

References

1. ^{Coates LC, Mease PJ, Gladman DD, et al. Secukinumab improves physical function and quality of life and inhibits structural damage in patients with PsA with sustained remission or low disease activity: results from the 2-year phase 3 FUTURE 5 study. RMD Open 2023;9:e002939. doi: 10.1136/rmdopen-2022-002939}