Reduced Synovial Inflammation With Secukinumab in Psoriatic Arthritis

Interleukin-17A (IL-17A) inhibition with secukinumab for 24 weeks results in a significant decrease of synovial inflammation in psoriatic arthritis (PsA), with no progression of anabolic and catabolic bone changes in patients’ joints, according to results of the PSARTOS study (ClinicalTrials.gov identifier: NCT02483234) published in Arthritis Research & Therapy.

To illuminate the effect of IL-17A inhibition on inflammation and joint bone changes, 20 patients with active PsA were enrolled in an open-label study of the IL-17A inhibitor secukinumab. High resolution peripheral quantitative computer tomography (HR-pQCT), power Doppler ultrasound, and magnetic resonance imaging (MRI) of participants’ hands were completed at baseline and again after 24 weeks of treatment to assess bone structure, enthesiophyte formation, bone erosion, periarticular inflammation, and synovitis. In addition, clinical and demographic measures of joint disease, skin disease, and composite measures (Disease Activity Score of 28 joints based on erythrocyte sedimentation rate [DAS28-ESR] and Disease Activity in PsA [DAPSA], psoriasis area severity index and body surface area, and minimal disease activity, respectively) were recorded as well.

After 24 weeks of treatment with secukinumab, patients saw significant improvements in the signs and symptoms of PsA, with 52% reaching DAPSA low disease activity and 46% reaching minimal disease activity. Signal in power Doppler ultrasound (P =.030) and MRI synovitis (P =.034) also significantly decreased. Functional bone strength and structural integrity remained stable after treatment, and bone erosions and enthesiophytes in the HR-pQCT and bone erosions in MRI showed no progression.

Study investigators conclude their study “shows that targeting IL-17 by secukinumab effectively controls synovitis and leads to an arrest of catabolic as well as anabolic structural bone changes in patients with PsA. These data underline a causative role of IL-17 in triggering joint disease in the context of psoriasis.”

This study was supported by FOREUM Foundation for Research in Rheumatology and Novartis.

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Reference

Kampylafka E, d’Oliveira I, Linz C, et al. Resolution of synovitis and arrest of catabolic and anabolic bone changes in patients with psoriatic arthritis by IL-17A blockade with secukinumab: results from the prospective PSARTROS study [published online July 27, 2018]. Arthritis Res Ther. doi: 10.1186/s13075-018-1653-5