Secukinumab Has High Retention Rate in Real-World Psoriatic Arthritis Study

A new study suggests secukinumab (Cosenytx) has a high retention rate among biologic-experienced patients with psoriatic arthritis (PsA) in real-world settings, and also produces minimal serious side effects.

The research is important because previous data on the real-world usage of the recombinant human monoclonal antibody has been scarce. The drug, which targets interleukin-17A, has been approved for the treatment of PsA since 2015 in Europe and 2016 in the United States.

A team of Greek investigators wanted to know specifically how patients with PsA fared on secukinumab if they had already taken a biologic. The investigators enrolled 75 biologic-experienced patients who were treated with secukinumab at 2 university rheumatology clinics between 2016 and 2018. Their findings were published in the journal Frontiers in Medicine.

Most of the patients (76%) were female. The patients had a mean age of 53.9 years, a median disease duration of 6.7 years, and a median treatment duration of 11.1 months with secukinumab.

Forty-eight (64%) patients had previously been exposed to anti-tumor necrosis factor (TNF) agents only. Five patients (7%) had been exposed only to ustekinumab, an IL-12/23 inhibitor. The remaining 22 patients had been exposed to both therapies.

Fifty-three percent of patients in the study received secukinumab in combination with non-biologics; 35% received the biologic along with glucocorticoids.

At baseline, 97% of patients had peripheral arthritis; 42% had axial involvement; 22% had enthesitis; and 12% had dactylitis, the authors reported.

At the end of the study’s follow-up period, peripheral arthritis scores improved, as did patients’ function scores, which were assessed by questionnaire. All patients with dactylitis at baseline saw the symptom resolve, as did 56% of patients with enthesitis at baseline.

Overall, the secukinumab survival rate was 64%, a rate that was not significantly affected by whether the patients were previously exposed to anti-TNFs only, or anti-TNFs and ustekinumab. The serious adverse event rate during follow-up was 4.8/100 patient-years, and the serious infection rate was 1.2/100 patient years.

Corresponding author Dimitrios Vassilopoulos, MD, of Hippokration General Hospital, in Athens, and colleagues said while the drug had performed well in randomized controlled trials (RCTs), a number of important factors made it important to attempt to gather real-world data.

“Our real life patient population had some unique characteristics compared to the RCTs,” Vassilopoulos and colleagues wrote. “This was a biologic-experienced, treatment-resistant population since almost all patients had been previously exposed to anti-TNFs (93%) and ~29% both to anti-TNF and anti-IL12/23 agents. Furthermore, these patients had long-standing, established disease (median: 6.7 years) and were recruited from university referral hospitals.”

One limitation of the study was that it was retrospective, and the authors said it is possible that their data are missing unreported adverse events. The follow-up period was also relatively short, they said.

Still, the overall findings lend evidence to support the idea that secukinumab can be a meaningful solution for this patient population.

“Our findings suggest that SEC [secukinumab] is an efficacious and well-tolerated biologic agent in this multi-resistant, difficult to treat patient group,” they said.

Reference

Klavdianou K, Lazarini A, Grivas A, et al. Real Life Efficacy and Safety of Secukinumab in Biologic-Experienced Patients With Psoriatic Arthritis. Front Med (Lausanne). Published online June 19, 2020. doi:10.3389/fmed.2020.00288