Does Prior TNFi Use Affect Secukinumab Effectiveness in Psoriatic Arthritis?
Secukinumab, a human anti-IL-17A monoclonal antibody, was shown to be effective in both tumor necrosis factor inhibitor (TNFi)-naïve and TNFi-exposed psoriatic arthritis patients, however greater improvements were noted in TNFi- naïve patients.
Researchers analyzed data from the FUTURE 2 study, an ongoing 5-year, randomized, double-blind, multicenter, placebo-controlled, parallel-group study. A total of 351 patients completed the study and were randomized to receive subcutaneous doses of secukinumab at 300mg, 150mg, 75mg, or placebo at baseline, and weeks 1, 2, 3, 4, and every 4 weeks thereafter.
The efficacy outcomes comprise of the proportion of patients with ≥20%, ≥50% or ≥70% improvement in American College of Rheumatology response criteria including, ACR20, ACR50, and ACR70 responses, respectively.
The ACR20 response rate for TNFi-naïve patients was 58.2% for the secukinumab 300mg subgroup at week 24 (P<0.0001); 63.5% for the 150mg group (P<0.0001); and 36.9% for the 75mg group (P<0.0001); compared with 15.9% in the placebo group.
Response rates were less for the TNFi-exposed group than the naïve group, but were still considerably greater than placebo rates. The ACR20 response rate for TNFi-exposed patients was 45.5% for the 300mg group (P<0.0001); 29.7% for the 150mg group (P<0.0001); and 14.9% for the 75mg group (P<0.01), compared with 14.3% in the placebo group.
These improvements noted at week 24 continued through to week 52 in both TNFi-naïve and TNFi-exposed patients; 68.7%, 79.4%, and 58.5% of TNFi-naive and 54.5%, 37.8%, and 35.3% of TNFi-exposed patients in the 300 mg, 150 mg, and 75 mg group, respectively, achieved an ACR20 response at Week 52.
The authors write that “these data suggest that secukinumab 150mg appears to be the most appropriate dose for TNFi-naive patients, but among TNFi-exposed patients, the 300mg dose seems to be more appropriate, especially among those patients with high levels of disease activity.”
Doses of 300mg and 150mg in the naïve patients were found to be effective regardless of concomitant methotrexate use, weight, or baseline disease activity, in a posthoc analyses. The authors registered the limitations of their study, noting the small size of the subgroups and the posthoc nature of some of the exploratory analyses of baseline disease characteristics.
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