New research suggests the monoclonal antibody can help repair erosion while also stunting enthesophyte progression.
Patients with psoriatic arthritis have less bone erosion and enthesophyte progression after one year of secukinumab treatment compared to placebo, according to new research from Hong Kong.
The researchers randomly assigned 40 adults with erosion at, but not destruction in, their metacarpophalangeal joints to receive subcutaneous injections of either 150mg secukinumab or placebo for four weeks, then once every month for the next 11 months.
Patients had active disease despite previous treatment with NSAIDs or conventional synthetic DMARDs. Only 18 participants in the secukinumab group and 16 patients in the placebo group completed the full year of treatment.
High-resolution peripheral quantitative CT imaging undertaken at baseline, week 24 and week 48 revealed secukinumab significantly reduced the amount of erosion and the formation of enthesophytes in the metacarpophalangeal joints.
Patients treated with secukinumab had a 2.8-fold increase in the odds of having partial erosion healing – and had a 74% reduction in the odds of enthesophytes progressing – compared to placebo.
Compared to patients in the placebo group, patients in the secukinumab group also displayed greater reductions in erythrocyte sedimentation rate and C-reactive protein after 12 months of treatment, as well as larger reductions on the Psoriasis Area and Severity Index, the Health Assessment Questionnaire and the Disease Activity in Psoriatic Arthritis scale. Both groups saw similar reductions in the number of tender, swollen and damaged joints.
“Despite the similar clinical response, a differential effect on bone damage was observed. This suggests that bone damage may be driven by pathway-specific mechanisms rather than solely by controlling inflammation,” the researchers concluded.
The number of patients affected by adverse events was higher in the secukinumab group compared to the placebo group (15 versus nine), as was the overall number of reported adverse effects (25 versus 15). However, no severe adverse effects occurred, and the most common adverse events were itchy skin rash, diarrhoea and deranged liver function.
“In this study, we demonstrated the feasibility of [the] antiproliferative effect of IL-17A inhibition in patients with PsA,” the authors wrote.
“Secukinumab can reduce bone erosion and prevent the progression of new bone formation, emphasising its advantageous impact in managing bone diseases in PsA patients.”
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But more information was needed to determine the clinical relevance of these findings, the authors said.
“In future studies, the correlation between imaging findings (erosion or enthesophyte volume) and clinical features (joint tenderness or swelling) as well as imaging modalities (ultrasound or magnetic resonance imaging) and histological activity (biopsy), should be further investigated,” they noted.
Meanwhile, a separate trial of secukinumab in 146 patients with psoriasis vulgaris, published in Acta Dermato-Venereologica, showed a reduction in itch intensity and PASI scores following 16 weeks of open label treatment.
A relapse of pruritus and PASI severity occurred when patients discontinued treatment as part of the phase 3 trial’s randomised withdrawal period, but benefits persisted for a further 16 weeks in patients who were assigned to continue secukinumab treatment.
