Very early intervention with secukinumab may be a feasible approach in PsA
medwireNews: Findings from a small study suggest that treatment with the interleukin-17A inhibitor secukinumab may be a promising strategy to reduce inflammation in psoriasis patients with subclinical peripheral joint involvement.
“We wanted to address inflammation in very early PsA [psoriatic arthritis] patients,” Axel Hueber (Friedrich-Alexander-University Erlangen-Nürnberg, Germany) told medwireNews at the 2018 ACR/ARHP Annual Meeting in Chicago, Illinois, USA.
As outlined in a poster presentation, the study involved 20 psoriasis patients with evidence of subclinical joint involvement as measured by magnetic resonance imaging (MRI), or erosive changes detected by MRI or high resolution peripheral quantitative computed tomography (CT).
“What is interesting is that of these patients with no diagnosis of arthritis, already 40% had tender joints, and there was a high amount of arthralgia” as indicated by the Visual Analog Scale (VAS) pain score, said Hueber. A total of 83% of participants had at least one inflammatory lesion on MRI at baseline.
After 24 weeks of secukinumab treatment, patients experienced significant improvements in Psoriasis Area and Severity Index score, body surface area affected by psoriasis, VAS pain, and tender joint counts from baseline.
Moreover, in a subanalysis of the patients with MRI inflammation at baseline, PsA magnetic resonance imaging scoring system (PsAMRIS) synovitis and total PsAMRIS scores improved significantly from baseline to week 24, and there was a significant correlation between changes in PsAMRIS and VAS pain scores.
“Intriguingly, in the 24 weeks there was no change in the bone structure with regard to erosions or osteoproliferation, either with MRI or with CT,” said Hueber.
Together, these findings suggest that “we have an interception in very early PsA that is feasible and can reduce some patient-reported outcomes, but also some independent biomarkers [of] inflammation,” he summarized.
Hueber noted, however, that the study was limited by its open-label design and lack of control arm.
Looking to the future, he said “we will follow up these patients [and] would love to extend this,” noting that a placebo-controlled study to assess how many patients progress in terms of PsA measures would be feasible.
“That would be interesting to address,” he remarked.
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