In very early and established psoriatic arthritis (PsA), interleukin (IL)-17A inhibition with secukinumab results in improvements in general health perception and mental well-being that vary across stage-based clusters, according to study results published in Arthritis Research and Therapy.
Patient-reported outcomes (PROs) may be valuable in understanding disease patterns and assessing the therapeutic potential to improve quality of life (QoL). In the current analysis, the researchers aimed to compare the effect of secukinumab on the QoL of patients with very early and established PsA, and explore whether this led to a reclustering of patients based on the effect of the disease on QoL.
Patients with early PsA from the IVEPsA study (N=20) and patients with established PsA from the PSARTROS study (N=20) were included in the current analysis (ClinicalTrials.gov Identifier: NCT02483234).
Of the 40 patients, 19 with early PsA and 17 with established PsA completed the study. All participants received secukinumab 300 mg weekly for 4 weeks and then monthly for a total of 24 weeks. Pain and global disease activity were assessed using visual analog scales (VAS), physical function by the Health Assessment Questionnaire Disability Index (HAQ-DI) and 36-Item Short Form Survey (SF-36), and mental function also using the SF-36; Joint health (78 tender joint counts and 76 swollen joint counts) were assessed in all patients. Researchers performed cross-sectional and prospective longitudinal evaluation of PROs and cluster analysis at baseline and 24 weeks.
In most of the PROs, there was rapid improvement within the first 4 weeks of the study. Changes in physical function and pain were more pronounced in patients with established PsA with greater joint disease burden. Compared with baseline, at 24 weeks, PRO-based clusters that distinguished between early and established PsA were not visible. At week 24, patients with established PsA who achieved minimal disease activity showed greater improvement in VAS pain, global disease activity, HAQ-DI, and SF-36 physical scores. Patients with early PsA had more significant changes in general PROs, such as emotional and mental well-being and global patient VAS.
In addition to an improvement in inflammation, which has been previously reported, IL-17A inhibition with secukinumab showed significant results in the improvement of multiple QoL measures. Apart from improvements in physical PROs, the researchers reported improvements in mental health and social functioning, suggesting that inhibition of IL-17A contributed more deeply to patient health than previously considered, even in patients with very early disease. Findings of divergence between treatment clusters showing an inverse physical and mental response to treatment point to a potential need for individual management strategies targeting each of these responses.
Study limitations included the small sample size and a relatively short follow-up of 6 months.
Researchers concluded, “Altogether, these data show that effective interventions in psoriatic disease lead to a reclustering of patients’ subgroups based on their PROs and health status.”
Kampylafka E, Tascilar K, Lerchen V, et al. Secukinumab leads to shifts from stage-based towards response-based disease clusters—comparative data from very early and established psoriatic arthritis. Arthritis Res Ther. Published online September 9, 2020. doi:10.1186/s13075-020-02268-y