Secukinumab in Early PsA Starts Fast vs Standard of Care

Medscape

6 days ago

TOPLINE:
More patients with recently diagnosed psoriatic arthritis (PsA) saw clinical improvement by 3 months in a treat-to-target strategy with secukinumab, a monoclonal antibody targeting interleukin-17, compared with those on standard-of-care treatment, but this difference was not seen at later 3-month intervals out to 1 year.
METHODOLOGY:
In a randomized, open-label, manufacturer-sponsored, multicenter trial, 120 patients (mean age, 49; 41% women) diagnosed with PsA within the prior 3 months were randomized to a treat-to-target approach of early treatment with secukinumab or standard of care in which treatment escalated according to predetermined steps if patients failed to respond.
At the start, in the secukinumab arm, 60 patients received 300 mg monthly secukinumab, a single injection of 80 mg triamcinolone, and 15 mg/wk methotrexate plus 10 mg/wk folic acid. In the standard-of-care arm, 60 patients received 80 mg triamcinolone (single injection), methotrexate starting at 15 mg/wk and increasing to 25 mg/wk by 6 weeks, and 10 mg/wk folic acid.
In the standard-of-care arm, treatment was escalated by adding sulfasalazine 1000 mg twice daily if needed, then switching if needed to a first or second TNF inhibitor with methotrexate.
In the secukinumab arm, patients with poor response were escalated to a TNF inhibitor with 25 mg methotrexate per week, followed by a second TNF inhibitor plus methotrexate if needed.
Outcomes were measured at 3, 6, 9, and 12 months, and the primary endpoint was the percentage of patients achieving 50% or greater improvement in American College of Rheumatology response criteria (ACR50) at 6 months.
TAKEAWAY:
At 6 months, both trial arms had similar ACR50 rates (around 41% in the secukinumab arm vs 37% in the standard-of-care arm).
However, first-line secukinumab was associated with significantly more patients achieving ACR50 at 3 months (about 42% vs 22%; P < .05).
Secondary endpoints of the percentage of patients meeting criteria for Minimal Disease Activity, 90% improvement in Psoriasis Area Severity Index, and resolution of enthesitis and dactylitis generally followed the same pattern of quicker responses in the secukinumab arm, followed by numerically greater but not statistically significant differences in the secukinumab vs standard-of-care arms at later timepoints.
IN PRACTICE:
'Early response is very important to patients. They don't necessarily care whether they are eventually going to catch up. They want to know they'll feel much better at 3 months,' commented Dafna Gladman, MD, senior scientist at the Toronto Western Research Institute and professor in the Institute of Medical Science at the University of Toronto, both in Toronto, Ontario, Canada. She was not a part of the study.
SOURCE:
Gonul Hazal Koc, MD, of Erasmus MC in Rotterdam, the Netherlands, led the research and presented the 12-month results in a poster at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 Annual Meeting and Trainee Symposium in Bogotá, Colombia.
LIMITATIONS:
The study was not blinded, and a treat-to-target approach, while recommended by several guidelines, does not necessarily represent routine clinical practice in PsA.
DISCLOSURES:
Koc and her colleagues' research was supported by an unrestricted grant to her institution by Novartis, the manufacturer of secukinumab, which also supplied the study drug.Koc reported having no financial relationships outside the grant to her institution. Gladman has received research support and/or consultant fees from AbbVie, Amgen, Bristol-Myers Squibb, Johnson & Johnson, Eli Lilly, Fresenius Kabi, Novartis, Galapagos, UCB, Gilead, Janssen, Roche, and Pfizer.