Treatment of psoriatic arthritis over 24 weeks with the human anti-interleukin-17A monoclonal antibody secukinumab allowed a significantly higher percentage of patients who received 150-mg and 300-mg doses to achieve at least 20% improvement in the American College of Rheumatology response criteria than did placebo.
The results of the multicenter, double-blind, randomized, placebo-controlled FUTURE 2 trial hinted at the effectiveness of the 300-mg dosing regimen in treating patients who previously had not responded to treatment with tumor necrosis factor (TNF) inhibitors and did not show differences in effectiveness when used together with methotrexate. The drug did not have any particularly worrisome treatment-related adverse events, Dr. Iain McInnes of the University of Glasgow (Scotland) and his colleagues reported (Lancet 2015 June 28 [doi:10.1016/S0140-6736(15)61134-5]).
At week 24, ACR20 responses occurred in 54 of 100 patients who received secukinumab 300 mg, 51 of 100 who took the 150-mg dosing regimen, 29 of 99 on the 75-mg dosing regimen, and 15 of 98 on placebo. The odds for achieving ACR20 at 24 weeks were nearly sevenfold higher for the 300-mg dose (odds ratio, 6.81; 95% confidence interval, 3.42-13.56; P < .0001) and 150-mg doses (OR, 6.52; 95% CI, 3.25-13.08; P < .0001) than with placebo.
In an editorial accompanying the report, Dr. Philip Helliwell and Dr. Laura Coates of the University of Leeds (England) said that it is important to note that responses at week 24 were similar to those observed at weeks 12 and 16 so that patients and physicians can “get an idea of response (or non-response) at an early timepoint” (Lancet 2015 June 28 [doi:10.1016/S0140-6736(15)61170-9]).
Although radiographic progression wasn’t assessed in the FUTURE 2 trial, Dr. Helliwell and Dr. Coates noted that secukinumab inhibited radiographic damage in the unpublished FUTURE-1 trial, so “in view of its position in the cytokine hierarchy, interleukin-17 inhibition might prevent both of these features, and future studies with this class of drug should investigate this issue in detail.”
The lower response that seemed to have occurred in the secukinumab-treated patients who had previously used TNF inhibitors vs. those who had not “is in keeping with data for other treatments such as ustekinumab,” they wrote. The fact that there appeared to be a dose-response effect between the patients who received 150 mg secukinumab vs. 300 mg and had previously used TNF inhibitors suggests that the 300-mg dose might be more appropriate for patients who did not respond to TNF inhibitors and/or have moderate to severe psoriasis, for whom the 300-mg dose is already approved and recommended.
Read our meeting coverage of the FUTURE 2 trial at ACR 2014 here.
