Friday, 14 Dec 2018

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Several Agents Score on Radiographic Progression in Psoriatic Arthritis

Reduction on radiographic progression has now become the standard of care in the therapies used to treat psoriatic arthritis and, during the 2017 ACR Meeting, several agents reported the results of their studies with radiographic endpoints.

Dr. Philip Mease presented the Future 5 study, the largest randomized controlled trial in psoriatic arthritis to date.
In this study 996 patients were treated with secukinumab 150mg loading, 150mg no loading, 300mg loading and placebo.
Approximately 30% of pts had experienced anti-TNF therapy.  Secukinumab significantly improved ACR20 at Wk 16 vs. PBO. Radiographic progression (mTSS) was significantly inhibited at Wk 24 in all secukinumab arms vs. PBO.

Also shown, was a greater proportion of pts with no radiographic progression (change from baseline in mTSS≤0.5) with secukinumab vs. PBO: 88% (300 mg), 79% (150 mg), 83% (150 mg without LD), and 73% (PBO).

A second study presented by Dr. Desiree Van Der Heijde on another anti IL17 agent, Ixekizumab, discussed the radiographic data of the 52 week extension of their SPIRIT P1 study, bio naive population. In this study 374 pts (98.2%) had radiographs and week 52 mean (SD) mTSS change from baseline were 0.54 (2.11) and 0.09 (1.0) for pts randomized to IXEQ4W and IXEQ2W at baseline, respectively.

The majority of IXEQ2W or IXEQ4W pts exhibited no structural progression through 1 year of IXE treatment. This was also the case on pts who switched from PBO or Adalimumab to IXE at 16 or 24 weeks. Week 52 mean change from baseline mTSS values scores ranged from -0.03 to 0.41 in these patients.

Lastly, the same author presented radiographic data of the oral JAK inhibitor Tofacitinib. In this study there was TNF comparator, namely adalimumab, and patients were TNF naive, with almost all patients being on a background DMARD. They also grouped the patients by baseline CRP levels. Patients in all groups demonstrated minimal changes from BL in mTSS, erosion, and JSN at M12. Change from baseline was similar in patients with CRP >2.87 mg/L or ≤2.87 mg/L. Radiographic Non-progression at M12 was seen >90% of pts in all groups. At M12, 95.9%,94.9%, and 97.9% of patients receiving tofacitinib 5 mg BID, tofacitinib 10 mg BID,and ADA, respectively, were non-progressors based on radiographic changes in mTSS.

Expect more to follow on all these agents in the next months as they establish themselves, or for secukinumab, continues to expand in the field of psoriatic arthritis.

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