MADRID -- Despite having been treated with numerous regimens, including multiple tries with biologic agents, many patients with psoriatic arthritis benefited from a 6-month course of secukinumab (Cosentyx) in a "real-world" analysis reported here.
Among 177 heavily pretreated patients, 47% achieved remission or low disease activity as measured by the DAPSA (Disease Activity in Psoriatic Arthritis) score, reported Maria Martin-Lopez, MD, of Hospital Universitario 12 de Octubre in Madrid.
"Secukinumab is a new option for the treatment of psoriatic arthritis which has showed efficacy on clinical trials," Martin-Lopez said in explaining the study's rationale. "However, real-world data of its use are still scarce."
In a poster presentation at the European Congress on Rheumatology, the European League Against Rheumatism's annual meeting, she and colleagues from three other tertiary hospitals in the Madrid area pooled retrospective data to get a handle on how secukinumab is performing in routine practice. An inhibitor of interleukin-17a, the drug was a pioneer in this relatively new class of agents for psoriatic arthritis.
About 90% of patients had previously received at least one conventional disease-modifying anti-rheumatic drug (DMARD), including 77% of the patients who had tried methotrexate. Two-thirds had previously used at least one biologic agent before they were treated with secukinumab.
Martin-Lopez characterized the outcomes as "favorable," noting her study included patients with more co-morbidities and more previous treatments than patients who were included in clinical trials.
At baseline the mean number of tender joints in the patients was seven but after 6 months therapy with secukinumab, the mean tender joint count was reduced to five, Martin-Lopez reported. The patients' swollen joint count was reduced from four to two.
Also, C-reactive protein levels declined from a mean baseline level of 7 mg/L to 5 mg/L and patients' mean DAPSA score was reduced from 26 to 17.
"This was a very heavily pretreated patient population," Augustin Latourte, MD, of Hôpital Lariboisière, Paris, told 51˶, "so the ability to get 47% of these patients into remission or achieving low disease activity means that this is a good result."
In the trial, 69% of the patients were treated with the 150-mg dose of secukinumab while the remaining 31% of patients received doses of 300 mg.
The researchers included any patients diagnosed with psoriatic arthritis and who had received at least one dose of secukinumab. Mean patient age was 53 and 65% were women. Patients' mean body mass index was 28, with more than one-third having BMI values of 30 or greater. The researchers noted that 28% of their treatment cohort were current smokers; 31% had hypertension; 12% were diabetic; 33% had high cholesterol levels. Mean duration of rheumatic disease was 9 years.
About 84% of the patients had psoriasis diagnoses in addition to psoriatic arthritis; 34% were diagnosed with dactylitis and 63% had enthesitis, Martin-Lopez reported. Of the 119 patients in the study who had previously been treated with biologics, 32% had been treated with one agent; 25% had tried two; 21% had used three; and 22% had been on four or more.
More than half the cohort (79 patients) eventually discontinued secukinumab, and 40 of those patients did so because of primary failure to improve their condition. Another 27 patients stopped the drug for secondary failure during the treatment course. Most of the others discontinuing did so because of adverse events. Martin-Lopez indicated that the adverse events seen in the study were the same as reported in secukinumab's clinical trials.
Disclosures
Martin-Lopez and Latourte disclosed no relevant relationships with industry.
Primary Source
European League Against Rheumatism
Martin-Lopez M, et al "Real-world experience of secukinumab for psoriatic arthritis" EULAR 2019; Abstract FRI0448.