Secukinumab produces durable remission in psoriatic arthritis
Treatment with secukinumab results in a higher rate of remission or low-disease activity (LDA) at week 16 in patients with psoriatic arthritis as compared with placebo, according to a posthoc analysis of the FUTURE 2 study. This effect is sustained at 2 years and is evident in both tumour necrosis factor inhibitor (TNFi)-experienced and -naïve patients.
Furthermore, secukinumab-treated patients achieving remission/LDA show significantly greater improvements in patient-reported outcomes (PROs), including physical function and different dimensions of health-related quality of life and work, relative to their counterparts with high-disease activity (HDA).
“Secukinumab, a fully human IgG1 monoclonal antibody that selectively neutralizes IL-17A, has substantial efficacy in the treatment of moderate to severe psoriasis, PsA and ankylosing spondylitis, demonstrating rapid onset of action and sustained responses with a favourable safety profile,” the investigators said.
“In the placebo-controlled, double-blind, phase III FUTURE 2 trial, [the drug induced] significant improvements in key clinical domains of PsA compared with placebo, and these improvements were sustained through week 104,” they added. [Lancet 2015;386:1137-1146;
In the current analysis, the investigators examined whether secukinumab-treated patients would achieve remission or LDA using Psoriatic Arthritis Disease Activity Score (PASDAS) scores at weeks 16, 52 and 104. The population comprised 100 patients who received the 300 mg dose (mean age 46.9 years; 49 percent female), 100 who received the 150 mg dose (mean age 46.5 years; 45 percent female) and 98 who were on placebo (mean age 49.9 years; 60.2 percent female).
At week 16, the respective PASDAS remission and LDA occurred in 15.6 percent and 22.9 percent of patients in the secukinumab 300-mg arm and 15.2 percent and 19.2 percent in the 150-mg arm vs 2.3 percent and 13.8 percent in the placebo arm. [Arthritis Res Ther 2018;20:272]
More patients in the TNFi-naïve group achieved remission/LDA with secukinumab 300 and 150 mg vs placebo (46.2 percent and 42.9 percent vs 17.5 percent). The corresponding responses in TNFi-experienced patients were 22.6 percent and 19.4 percent vs 13.3 percent.
Remission/LDA responses with secukinumab were sustained through 2 years, and patients who achieved these outcomes reported greater improvements in PROs than patients in HDA during this period.
Results of the current analysis further demonstrate the ability of the drug to produce PASDAS-based remission or LDA through 2 years, extending the previous findings of maintenance of other stringent clinical efficacy outcomes, including very low disease activity and minimal disease activity, the investigators said. “This demonstrate[s] the potential utility of PASDAS as an outcome measure in randomized clinical trials [RCTs] in PsA.”
“The PASDAS has certain limitations in that, being a complex composite index, it requires complex mathematical calculations, which are time-consuming, although this has been overcome with an application allowing for an easy calculation. PASDAS thus may be more appropriately used in RCTs,” they explained.
“Moreover, PASDAS-based publications on RCT data are sparse to place it in context with other composite indices used in PsA … These data will require confirmation in new RCTs,” the investigators said.