Secukinumab Treatment Effective Up to 5 Years in PsO, PsA

Treatment with secukinumab, a selective interleukin (IL)-17 inhibitor, demonstrated efficacy for up to 5 years in a cohort of patients with and psoriasis and psoriatic arthritis (PsA), with high drug survival (DS), according to data published in the Journal of Personalized Medicine.¹

“The efficacy of secukinumab has been assessed on the erythrodermic and pustular forms of psoriasis in recent real-life experience, as in difficult-to-treat regions such as palmoplantar sites,” wrote a team of investigators led by Luca Mastorino, MD, associated with the Department of Medical Sciences, Section of Dermatology, at the University of Turin. “Real-life studies have highlighted the good efficacy and safety of the drug for up to 2 years of treatment, with conflicting results on drug survival (DS), ranging from 74.3% to 59%.”

However, real-world efficacy, safety, and DS of the drug for > 2 years of treatment are scarce.²

To assess the long-term efficacy and DS of secukinumab in this patient population, investigators conducted a retrospective real-world analysis. Adult patients with moderate-to-severe psoriasis or PsA treated with secukinumab at the Dermatologic Clinic of the Turin University Hospital were assessed between January 2017 and February 2023. Patients were treated with 300 mg of secukinumab weekly during the first 4 weeks and then once monthly thereafter.

Investigators evaluated the achievement of Psoriasis Area Severity Index (PASI)100, PASI90, PASI ≤ 3, and DS up to 260 weeks. Discontinuation was defined as the date treatment was interrupted due to reasons including side effects, primary or secondary failure, or when treatment was switched to another medication.

A multivariate analysis considered age, sex, age of disease onset, obesity, diabetes, psoriatic arthritis, cardiovascular comorbidities, treatment-naïve status, baseline PASI, and any difficult-to-treat sites.

A total of 255 patients receiving secukinumab were included in the analysis, of which 64.3% were male and 35.7% were female. The mean age was 58 years, the mean age of psoriasis onset was 36 years, and PsA was present in 35.7% of patients. Nearly half (45.6%) of patients had cardiovascular comorbidities, 42.35% of patients reported smoking, and 13.4% were diagnosed with diabetes. The number of patients dwindled throughout the 5-year period, with only 17 patients reaching the 260-week mark.

PASI100 was achieved by 41.7% of patients at week 16 and 70.6% of patients at week 260. Similarly, 46.5% of patients were able to obtain PASI90 at week 16 and 88.2% at week 260.

Patients who were not obese demonstrated a faster response to treatment compared with obese patients in achieving PASI100 (55% vs 44%; P = .033), PASI90 (64% vs 49%; P = .038), and PASI ≤ 3 (76% vs 62%; P = .036). The DS for secukinumab was 84.3% at month 12 and 48% at month 60. Higher rates of discontinuation were observed in patients who were obese (hazard ratio [HR] 1.6 CI 1.05 - 2.45, P = .028) and those who smoked (HR 1.48 CI 1.01 - 2.17, P = .043).

The main cause of secukinumab discontinuation was drug inefficacy (50.4%). The adverse events reported, such as rhinitis, diarrhea, candidiasis, otitis, and transaminitis, did not often lead to discontinuation. Other reasons for discontinuation included primary failure (17.7%).

Investigators mentioned the real-life and retrospective design as the main limitation. Additionally, generalizability was hindered due to the small sample size at weeks 206 and 260.

“Obesity appears to be the main obstacle for response and maintenance of DS,” investigators noted. “Difficult-to-treat site involvement, previous use of biological drugs, and joint involvement had little impact on the long-term response and therapeutic survival of secukinumab.”

References

1. ^{Mastorino L, Dapavo P, Cariti C, et al. Drug Survival, Safety, and Effectiveness of Secukinumab for up to 5 Years in Patients with Psoriasis and Psoriatic Arthritis: A Long-Term Real-Life Experience. J Pers Med. 2024;14(7):718. Published 2024 Jul 3. doi:10.3390/jpm14070718}
2. ^{Mendes-Bastos, P.; Morais, P.; Ferreira, P.; Loureiro, M.; Sanganha, J.; Santiago, L.; Basto, A.S.; Henrique, M. Persistence, effectiveness, and real-world outcomes in psoriasis patients treated with secukinumab in Portugal. Dermatol. Ther. 2022, 35, e15510.}