Similar Drug Survival for Ustekinumab, Secukinumab in Psoriatic Arthritis

The following article is part of conference coverage from the 2018 American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting in Chicago, Illinois. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from ACR/ARHP 2018 .

CHICAGO — The use of ustekinumab and secukinumab is associated with similar drug survival and efficacy among patients with psoriatic arthritis (PsA), but remission based on very low disease activity (VLDA) criteria was achieved more frequently with secukinumab, according to data from a real-world study presented at the 2018 ACR/ARHP Annual Meeting, held October 19-24 in Chicago, Illinois.

The investigators sought to evaluate drug survival, efficacy, and disease remission with ustekinumab vs secukinumab in a cohort of 161 patients with PsA. The mean patient age was 50.2 years, the mean body mass index (BMI) was 27.6 kg/m², and 54.7% of the participants were women. In addition, the duration of disease was 9.6 years, and 47.7% of the participants did not smoke. The study took place between July 2011 and April 2018, and mean follow-up was ≥6 months. Drug survival was defined as the time from initiation to discontinuation of biologic therapy.

In patients with peripheral forms of PsA, treatment was considered effective for those with a favorable expert opinion or >30% clinical improvement in swollen and tender joint counts. For axial forms of PsA, efficacy criteria included improvement in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) by ≥2 points on a scale from 0 to 10, 50% improvement (BASDAI 50), or expert opinion. Remission was considered with tender joint counts ≤1, swollen joint counts ≤1, Psoriasis Area Severity Index ≤1, patient visual analog scale (VAS) ≤15, Patient Global Activity VAS ≤20, and tender entheseal points ≤1 (VLDA criteria except Health Assessment Questionnaire).

Overall, 94.9% of the patients presented with peripheral PsA, 59.0% presented with axial PsA, and 31.4% presented with enthesitis. Moreover, 13.0% of the participants were naive to biologic disease-modifying antirheumatic drugs (bDMARDs). Median drug survival with ustekinumab and secukinumab was 11 months vs 12 months, respectively. Gender, age, disease duration, BMI, and smoking status had no effect on drug survival. In addition, drug survival was similar among ustekinumab-naive and secukinumab-naive patients (hazard ratio, 1.07; 95% CI, 0.67-1.70; P =.77), as was efficacy with both treatments (P =.15). In contrast, remission was significantly higher in the secukinumab group than in the ustekinumab group (36.2% vs 18.2%, respectively; P =.012).

According to the investigators, this is the first real-world study to compare these 2 new bDMARDs in patients with PsA. Both agents demonstrated similar efficacy and drug survival, but remission based on VLDA criteria was attained more often with secukinumab compared with ustekinumab.

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Reference

Letarouilly JG, Sellam J, Richette P, et al. Drug survival of non TNF inhibitors bDMARDs in psoriatic arthritis (ustekinumab/secukinumab): a real-word multicentric cohort of 161 patients. Presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. Abstract 2618.

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