Psoriatic arthritis (PsA), a chronic inflammatory arthritis characterized by structural damage to the joints, has been associated with reduced health-related quality of life, disability and reduced life expectancy. The joint changes in PsA are characterized radiographically by a combination of erosive and proliferative bone changes, including erosive joint destruction, fluffy periostitis and pencil-in-cup deformities. Radiographic assessment of joints is recommended to aid in the diagnosis of PsA, provide information on disease severity and assess the effect of treatment on disease progression.
These researchers set out to assess whether secukinumab treatment in patients with active PsA is associated with sustained inhibition of radiographic progression.
Methods: In this phase III, double-blind, placebo-controlled study, 606 patients with PsA were randomized to receive intravenous (IV) secukinumab at a dose of 10 mg/kg (Weeks 0, 2, 4) followed by subcutaneous secukinumab at a dose of 150 mg or 75 mg (the IVfi150 mg and IVfi75 mg groups, respectively) or placebo. Patients were stratified according to prior anti–tumor necrosis factor (anti-TNF) exposure (71% were anti-TNF naive). At Week 16, placebo-treated patients who had at least a 20% reduction in the tender and swollen joint counts (responders) continued to receive placebo until Week 24; nonresponders were re-randomized to receive secukinumab at a dose of 150 mg or 75 mg. The modified total Sharp/van der Heijde score (SHS) was determined at baseline, Week 16 or 24, and Week 52.
Results: The results of the current study demonstrate that secukinumab inhibited radiographic disease progression in the overall PsA patient population, and that this inhibition was sustained for up to 52 weeks. Inhibition was observed for both erosion and JSN scores. Furthermore, progression in placebo-treated patients was inhibited by switching to secukinumab treatment. In patients who showed the highest levels of radiographic progression, suboptimal secukinumab concentrations may have been linked to an increased likelihood of progression.
Inhibition of structural damage was demonstrated through Week 52, regardless of whether patients were receiving concomitant MTX, although these data should be interpreted with caution due to the fact that patients had active disease despite receiving MTX.
Also, compared with placebo, secukinumab significantly reduced radiographic progression, demonstrating a disease-modifying effect.
Excerpted and adapted from:
van der Heijde D, Landewé RB, Mease PJ, et al. Secukinumab provides significant and sustained inhibition of joint structural damage in a phase III study of active psoriatic arthritis. Arthritis Rheumatol. 2016 Aug;68(8):1914–1921.