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      Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Psoriatic Arthritis: Final 5‐year Results from the Phase 3 FUTURE 1 Study

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          Abstract

          Objective

          To report the 5‐year efficacy and safety of secukinumab in the treatment of patients with psoriatic arthritis (PsA) in the FUTURE 1 study ( NCT01392326).

          Methods

          Following the 2‐year core trial, eligible patients receiving subcutaneous secukinumab entered a 3‐year extension phase. Results are presented for key efficacy endpoints for the secukinumab 150‐mg group (n = 236), including patients who escalated from 150 to 300 mg (approved doses) starting at week 156. Safety is reported for all patients (n = 587) who received 1 dose or more of study treatment.

          Results

          Overall, 81.8%% (193 of 236) of patients in the secukinumab 150‐mg group completed 5 years of treatment, of which 36.4% (86 of 236) had dose escalation from 150 to 300 mg. Sustained improvements were achieved with secukinumab across all key efficacy endpoints through 5 years. Overall, 71.0%/51.8%/36.3% of patients achieved American College of Rheumatology ( ACR) 20/50/70 responses at 5 years. Efficacy improved in patients requiring dose escalation from 150 to 300 mg and was comparable with those who did not require dose escalation. Exposure‐adjusted incidence rates for selected adverse events per 100 patient‐years for any secukinumab dose were serious infections (1.8), Crohn's disease (0.2), Candida infection (0.9), and major adverse cardiac events (0.5).

          Conclusion

          Secukinumab provided sustained improvements in the signs and symptoms in the major clinical domains of PsA. Efficacy improved for patients requiring dose escalation from 150 to 300 mg during the study. Secukinumab was well tolerated with no new safety signals.

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          Most cited references14

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          Psoriatic arthritis: epidemiology, clinical features, course, and outcome.

          Psoriatic arthritis (PsA) has been defined as a unique inflammatory arthritis associated with psoriasis. Its exact prevalence is unknown, but estimates vary from 0.3% to 1% of the population. The clinical features described initially are recognised by most experienced clinicians, although they are most distinct in early disease. Initially, PsA typically presents as an oligoarticular and mild disease. However, with time PsA becomes polyarticular, and it is a severe disease in at least 20% of patients. Patients with PsA who present with polyarticular disease are at risk for disease progression. In addition to progression of clinical and radiological damage, health related quality of life is reduced among patients with PsA. It important to note that patients included in recent drug trials resemble patients followed prospectively in a clinic.
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            Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis.

            To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA).
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              Efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriatic arthritis: a 24-week, randomised, double-blind, placebo-controlled, phase II proof-of-concept trial.

              To evaluate the efficacy and safety of secukinumab, a fully human, anti-interleukin (IL)-17A monoclonal antibody, in patients with psoriatic arthritis (PsA). 42 patients with active PsA fulfilling ClASsification for Psoriatic ARthritis (CASPAR) criteria were randomly assigned (2:1) to receive two intravenous secukinumab doses (10 mg/kg; n=28) or placebo (n=14) 3 weeks apart. The primary endpoint was the proportion of American College of Rheumatology (ACR) 20 responses at week 6 for secukinumab versus placebo (one-sided p<0.1). Primary endpoint: ACR20 responses at week 6 were 39% (9/23) for secukinumab versus 23% (3/13) for placebo (p=0.27). ACR20 responses were greater with secukinumab versus placebo at week 12 (39% (9/23) vs 15% (2/13), p=0.13) and week 24 (43% (10/23) vs 18% (2/11), p= 0.14). At week 6, 'good' European League Against Rheumatism response was seen in 21.7% (5/23) secukinumab versus 9.1% (1/11) placebo patients. Compared with placebo at week 6, significant reductions were observed among secukinumab recipients for C reactive protein (p=0.039), erythrocyte sedimentation rate (p=0.038), Health Assessment Questionnaire Disability Index (p=0.002) and Short Form Health Survey (SF-36; p=0.030) scores. The overall adverse event (AE) frequency was comparable between secukinumab (26 (93%)) and placebo (11 (79%)) recipients. Six serious AEs (SAEs) were reported in four secukinumab patients and one SAE in one placebo patient. Although the primary endpoint was not met, clinical responses, acute-phase reactant and quality of life improvements were greater with secukinumab versus placebo, suggesting some clinical benefit. Secukinumab exhibited satisfactory safety. Larger clinical trials of secukinumab in PsA are warranted.
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                Author and article information

                Contributors
                pmease@philipmease.com
                Journal
                ACR Open Rheumatol
                ACR Open Rheumatol
                10.1002/(ISSN)2578-5745
                ACR2
                ACR Open Rheumatology
                John Wiley and Sons Inc. (Hoboken )
                2578-5745
                14 November 2019
                January 2020
                : 2
                : 1 ( doiID: 10.1002/acr2.v2.1 )
                : 18-25
                Affiliations
                [ 1 ] Swedish Medical Center/Providence St. Joseph Health and University of Washington Seattle Washington USA
                [ 2 ] University of California San Diego San Diego California USA
                [ 3 ] Dallas VA and University of Texas Southwestern Medical Center Dallas Texas USA
                [ 4 ] Whipps Cross University Hospital Barts Health NHS Trust London UK
                [ 5 ] Friedrich‐Alexander‐University Erlangen‐Nürnberg (FAU) Universitätsklinikum Erlangen Erlangen Germany
                [ 6 ] Monash University Melbourne Australia
                [ 7 ] University of Hasselt, Hasselt, Belgium, and Maastricht University Hospital Maastricht Belgium
                [ 8 ] Novartis Pharma AG Basel Switzerland
                [ 9 ] Novartis Pharmaceuticals Corporation East Hannover New Jersey USA
                Author notes
                [*] [* ]Address correspondence to Philip J. Mease, MD, Department of Rheumatology, Swedish Medical Center/Providence St. Joseph Health, and University of Washington, Seattle, Washington 98104, USA. E‐mail: pmease@ 123456philipmease.com .
                Author information
                https://orcid.org/0000-0002-6620-0457
                https://orcid.org/0000-0002-2569-2029
                Article
                ACR211097
                10.1002/acr2.11097
                6957920
                31943974
                73150d85-f4b7-4aaf-ac91-b59983dd0eff
                © 2019 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 21 June 2019
                : 23 September 2019
                Page count
                Figures: 3, Tables: 3, Pages: 8, Words: 5991
                Funding
                Funded by: Novartis
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.4 mode:remove_FC converted:14.01.2020

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