Patients who were tumor necrosis factor inhibitor naive generally had better responses to secukinumab compared with those who were inadequate responders—but both groups benefited
Patients with psoriatic arthritis (PsA) saw their symptoms improve with Cosentyx (secukinumab), regardless of whether they had previously been prescribed tumor necrosis factor inhibitors (TNFi), according to a new study.
The report also found TNFi-naive patients had the best results, suggesting secukinumab should be considered as a first-line therapy in PsA. The findings were published in Rheumatology and Therapy.
Although TNFi agents are commonly used to treat PsA, a proportion of patients do not benefit from the therapy. These patients are known as inadequate responders (TNF-IR) and their cases are generally considered more difficult to treat.
Secukinumab is a fully human monoclonal antibody targeting interleukin (IL)-17A. The drug has been approved to treat psoriasis, among other conditions, and has been shown to be effective in providing relief to some patients with PsA.
Corresponding author Ana-Maria Orbai, MD, MHS, of the Johns Hopkins University School of Medicine, and colleagues, wanted to understand how well secukinumab would work for patients who had previously taken TNFi. They investigated whether the therapy might prove to be a meaningful treatment option for inadequate responders.
To test their hypothesis, the authors used data from 4 phase 3 studies to create a cohort of 2049 patients with PsA. They determined efficacy using the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and endorsed by Outcome Measures in Rheumatology core domains at week 16. Results were compared among 3 groups: those receiving 300-mg doses of secukinumab, those receiving 150-mg doses, and those receiving placebo. In each of the 3 pooled arms, about 30% of patients were inadequate responders to TNFi therapy.
However, the data do show significant improvement in both secukinumab groups, although the impact was greater for those who were TNFi naive.
“Among patients treated with secukinumab 300 mg, 41.5% and 24.4% of TNFi-naive patients (P < .05 vs placebo) and 18.6% and 9.0% of TNF-IR patients (nonsignificant vs placebo) experienced resolution in 66 swollen and 68 tender joint counts, respectively; additionally, 37.2% of TNFi-naive patients and 24.2% of TNF-IR patients achieved complete resolution of psoriasis at week 16 (all P < .05 vs placebo),” the investigators reported.
They said these and other recent reports suggest that biologics targeting PsA-specific inflammatory cytokines may be beneficial first-line options for patients with PsA.
“The observed improvements with secukinumab treatment in TNF-IR and especially in TNFi-naive patient populations across all GRAPPA domains strengthen the evidence supporting secukinumab use as a first-line PsA therapy,” the authors wrote, adding that real-world data suggest secukinumab is already being commonly prescribed to biologic-experienced patients with PsA.
The authors noted a few limitations, including the pooled nature of their data, and the fact that the studies were conducted at different times and places, and with a relatively short follow-up period. They said a longer follow-up period could potentially have demonstrated additional benefits among the TNF-IR group.
The authors also noted that the efficacy of secukinumab is meaningful given the heterogeneity of the PsA disease spectrum, as well as differences in how the disease affects the quality of life of different patients.
Orbai A-M, Husni ME, Gladman DD, et al. Secukinumab efficacy on psoriatic arthritis GRAPPA-OMERACT core domains in patients with or without prior tumor necrosis factor inhibitor use: pooled analysis of four phase 3 studies. Rheumatol Ther. Published online July 3, 2021. doi:10.1007/s40744-021-00337-5