Low rates of radiographic progression with secukinumab treatment in PsA patients
medwireNews: Secukinumab-treated patients with psoriatic arthritis (PsA) have low rates of radiographic progression irrespective of prior treatment with tumor necrosis factor (TNF) inhibitors or concomitant methotrexate use, suggests a subgroup analysis of the FUTURE 5 trial.
Among the 996 patients with active PsA who participated in FUTURE 5, those who were randomly assigned to receive subcutaneous secukinumab at a dose of 150 mg every 4 weeks with or without a loading dose (LD) of 150 mg once weekly for the first 4 weeks, and those who received secukinumab 300 mg every 4 weeks following a 300 mg LD, had significantly less radiographic progression from baseline to week 24 than placebo-treated patients, with corresponding mean changes in modified Sharp/van der Heijde scores of 0.17, –0.09, and 0.08 versus 0.50 points.
Desirée van der Heijde (Leiden University Medical Centre, the Netherlands) told delegates at the EULAR 2018 meeting in Amsterdam, the Netherlands, that both patients who were TNF inhibitor-naïve and those with a previous inadequate response or intolerance to anti-TNF treatment (anti-TNF IR) experienced lower rates of radiographic progression with secukinumab versus placebo, but that the benefit appeared to be greater in the TNF inhibitor-naïve subgroup.
Indeed, for the 666 participants with no prior exposure to TNF inhibitors, average changes in modified Sharp/van der Heijde scores were 0.12, –0.25, and 0.01 points in the secukinumab 150 mg, 150 mg without LD, and 300 mg groups, respectively, compared with 0.48 points for those given placebo, with a significant difference in all comparisons.
And among the 270 patients with anti-TNF IR, the corresponding mean changes in modified Sharp/van der Heijde scores were 0.29, 0.31, and 0.23 versus 0.54 points. These differences were not statistically significant, which van der Heijde believes is “because the effect is smaller [than in TNF inhibitor-naïve patients] and also because the group of patients is much smaller, with around 65 patients per group.”
She reported that when the results were analyzed by concomitant methotrexate use, patients who were and were not receiving methotrexate experienced a comparable level of reduction in radiographic progression with secukinumab treatment.
Average changes in modified Sharp/van der Heijde scores were 0.18, –0.03 and 0.10 points for patients who received methotrexate alongside secukinumab 150 mg, 150 mg with no LD, and 300 mg, respectively, compared with 0.54 points for those given methotrexate plus placebo, and the corresponding changes for patients who did not receive concomitant methotrexate were 0.16, –0.17, and 0.06 versus 0.46 points.
van der Heijde concluded that “overall, low rates of radiographic progression were observed regardless of prior anti-TNF therapy and the concomitant use of methotrexate.”
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