Secukinumab treatment of psoriatic arthritis in real world: Achievement of fast response results in effective and lasting treatment outcomes

Background: Individualized treatment strategies are of high importance in the treatment of patients with chronic immune-mediated diseases such as psoriatic arthritis (PsA). IL17 inhibition has demonstrated good efficacy on all manifestations of PsA but in some patients a lack of efficacy can be observed. To analyze patient characteristics leading to treatment response patterns in PsA patients, data from the German non-interventional study “AQUILA” (Kiltz et al. 2019) was analyzed. Methods: The non-interventional study “AQUILA” includes, in addition to patients with axial spondyloarthritis, patients with active PsA. In the current analysis patients started treatment within a period of 4 weeks around their baseline visit (V1) and were followed-up over 52 weeks (V2-V6). Response in this cohort was defined as a combination of patient- (PsAID-12) and physician-derived (PhGA) assessments. Patients who reached a state of remission (PsAID-12 ≤ 1.4 and PhGA ≤ 1) or adequate improvement (20% improvement in PsAID-12 and PhGA compared to baseline) at any time during the study period were considered responders. A fast response was defined as reaching at least adequate improvement within the first 8 weeks of treatment (V2), all other responses were considered as late responses. Results: A cohort of 914 PsA patients was analyzed and divided into 3 subgroups (Table 1). Among fast responders, number of smokers was significantly lower (p=0.009) with a lower median BMI (p=0.004). Fast response was associated with a stronger and longer lasting therapy effect during further study course compared to late response: 50% response (p=0.003), remission state (p=0,019) and measurable response at week 52 (p=0.051) according to the definitions above were observed more often. Conclusion: Our results show that secukinumab is an effective biologic treatment in PsA patients. As with every available treatment option, its response is dependent on demographics and disease characteristics. The results underline the dependency of fast response on clinical phenotype. Fast responders seem to benefit from both fast alleviation of symptoms and longer lasting treatment effects.