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Orbai AM, McInnes IB, Coates LC, Husni ME, Gladman DD, Gossec L, Pricop L, Chambenoit O, Meng X, Mease PJ. Effect of Secukinumab on the Different GRAPPA-OMERACT Core Domains in Psoriatic Arthritis: A Pooled Analysis of 2049 Patients. J Rheumatol 2019; 47:854-864. [PMID: 31615919 DOI: 10.3899/jrheum.190507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare the efficacy of secukinumab with that of placebo across the updated Group for Research and Assessment of Psoriasis and Psoriatic Arthritis and Outcome Measures in Rheumatology (GRAPPA-OMERACT) individual psoriatic arthritis (PsA) core domains using pooled data from 4 phase III PsA studies and 1 phase III ankylosing spondylitis (AS) study. METHODS Data were pooled from 2049 patients with PsA participating in 4 on-label phase III PsA studies (FUTURE 2-5), and the efficacy of each GRAPPA-OMERACT PsA core domain (musculoskeletal disease activity, skin disease activity, pain, patient's global assessment, physical function, health-related quality of life, fatigue, and systemic inflammation) was assessed using multiple measures and definitions specific to each domain. The MEASURE 2 study, a phase III clinical trial in patients with AS, was used to assess improvement in spine symptoms at Week 16. RESULTS Treatment with secukinumab demonstrated robust and consistent efficacy across all GRAPPA-OMERACT PsA core domains, with secukinumab 300 mg showing the greatest response rates across most PsA core domains compared with placebo at Week 16. Notably, among patients treated with secukinumab 300 mg, 34.3% and 19.5% achieved complete resolution of swollen and tender joint counts, respectively; 53.2% and 61.5% achieved complete resolution of enthesitis and dactylitis, respectively; and 33.2% achieved 100% improvement in Psoriasis Area and Severity Index (all p < 0.05 vs placebo); similar improvements were shown for all other core domains. CONCLUSION This analysis suggests that secukinumab can benefit people with PsA across the clinical phenotypic spectrum commonly encountered in this disease.
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Affiliation(s)
- Ana-Maria Orbai
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA. .,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis. .,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington.
| | - Iain B McInnes
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Laura C Coates
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - M Elaine Husni
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Dafna D Gladman
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Laure Gossec
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Luminita Pricop
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Olivier Chambenoit
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Xiangyi Meng
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
| | - Philip J Mease
- From the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; University of Glasgow, Glasgow; University of Oxford, Oxford, UK; Cleveland Clinic, Cleveland, Ohio, USA; Toronto Western Research Institute and University of Toronto, Toronto, Ontario, Canada; Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique; Pitié Salpêtrière Hospital, AP-HP, Paris, France; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, Washington, USA.,A.M. Orbai has received grant support and consulting fees from Novartis. I.B. McInnes has received consulting fees from Novartis. L.C. Coates has received grant support, consulting fees, and speakers bureau fees from Novartis. D.D. Gladman has received grant support and consulting fees from Novartis. L. Gossec has received consulting fees from Novartis. L. Pricop, O. Chambenoit, and X. Meng are employees and stockholders of Novartis. P.J. Mease has received research grants, consulting fees, and speakers bureau fees from Novartis.,A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine; I.B. McInnes, MD, PhD, University of Glasgow; L.C. Coates, MBChB, PhD, University of Oxford; M.E. Husni, MD, MPH, Cleveland Clinic; D.D. Gladman, MD, FRCPC, Toronto Western Research Institute and University of Toronto; L. Gossec, MD, PhD, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Pitié Salpêtrière Hospital, AP-HP; L. Pricop, MD, Novartis Pharmaceuticals Corp.; O. Chambenoit, PhD, Novartis Pharmaceuticals Corp.; X. Meng, PhD, Novartis Pharmaceuticals Corp.; P.J. Mease, MD, Swedish Medical Center/Providence St. Joseph Health and University of Washington
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Abstract
Secukinumab (Cosentyx®), a first-in-class fully human monoclonal antibody against interleukin-17A, is approved in several countries, including the USA and those of the EU, for the treatment of ankylosing spondylitis (AS). Subcutaneous secukinumab significantly improved the clinical signs and symptoms of AS versus placebo in three of four phase III trials. The benefits of secukinumab were generally seen regardless of whether patients had or had not received previous tumour necrosis factor (TNF) inhibitor therapy, and were sustained during longer-term (up to 5 years) treatment. Secukinumab was also associated with improvements in spinal mobility, physical function, health-related quality of life and work productivity in some of the trials. In MEASURE 1, secukinumab reduced inflammation in the sacroiliac joint, and slowed radiographic progression. Secukinumab was generally well tolerated during up to 5 years’ treatment; the most commonly reported adverse event was nasopharyngitis. In the minority of patients who developed anti-drug antibodies (ADAs), ADAs did not decrease efficacy or increase adverse events. In conclusion, secukinumab is an effective therapy for TNF inhibitor-naive patients with active AS, and provides a useful treatment option for patients who have an inadequate response to or are intolerant of TNF inhibitors.
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Bilal J, Berlinberg A, Riaz IB, Faridi W, Bhattacharjee S, Ortega G, Murad MH, Wang Z, Prokop LJ, Alhifany AA, Kwoh CK. Risk of Infections and Cancer in Patients With Rheumatologic Diseases Receiving Interleukin Inhibitors: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1913102. [PMID: 31626313 PMCID: PMC6813598 DOI: 10.1001/jamanetworkopen.2019.13102] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The safety profile of interleukin (IL) inhibitors is not well established. OBJECTIVE To assess the risk of serious infections, opportunistic infections, and cancer in patients with rheumatologic diseases treated with IL inhibitors. DATA SOURCES Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations; Ovid MEDLINE Daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; and Scopus were searched (inception to November 30, 2018). STUDY SELECTION Randomized, placebo-controlled trials that evaluated IL inhibitor therapies in rheumatic diseases and reported safety data were included in the analyses. DATA EXTRACTION AND SYNTHESIS This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two investigators independently extracted study data and assessed risk of bias and certainty in the evidence. Fixed-effects meta-analysis was conducted to pool odds ratios (ORs) for serious infections, opportunistic infections, and cancers for IL inhibitors vs placebo. MAIN OUTCOMES AND MEASURES The outcomes of interest were the number of serious infections, opportunistic infections, and cancers in individuals receiving IL inhibitor therapies compared with placebo. RESULTS In this meta-analysis, 74 studies comprising 29 214 patients (24 236 patients for serious infections, 9998 for opportunistic infections, and 21 065 for cancer [number of patients overlaps for each outcome]) were included. Patients receiving IL inhibitors had a higher risk of serious infections (OR, 1.97; 95% CI, 1.58-2.44; P < .001, I2 = 0%; high certainty), opportunistic infections (OR, 2.35; 95% CI, 1.09-5.05; P = .03, I2 = 0%; moderate certainty), and cancer (OR, 1.52; 95% CI, 1.05-2.19; P = .03, I2 = 11%; moderate certainty). CONCLUSIONS AND RELEVANCE The risk of serious infections, opportunistic infections, and cancer appears to be increased in patients with rheumatologic diseases who are treated with IL inhibitors compared with placebo.
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Affiliation(s)
- Jawad Bilal
- Division of Rheumatology, Department of Medicine, University of Arizona, Tucson
| | - Adam Berlinberg
- Division of Rheumatology, Department of Medicine, University of Colorado, Denver
| | - Irbaz Bin Riaz
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Warda Faridi
- Division of Hematology/Oncology, Department of Medicine, University of Arizona, Tucson
| | - Sandipan Bhattacharjee
- College of Pharmacy, Department of Pharmacy Practice and Science, University of Arizona, Tucson
| | | | - Mohammad H. Murad
- Evidence-Based Practice Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Zhen Wang
- Evidence-Based Practice Center, Mayo Clinic Rochester, Rochester, Minnesota
| | - Larry J. Prokop
- Mayo Clinic Libraries, Mayo Clinic Rochester, Rochester, Minnesota
| | - Abdullah A. Alhifany
- College of Pharmacy, Department of Clinical Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - C. Kent Kwoh
- Division of Rheumatology, Department of Medicine, University of Arizona, Tucson
- University of Arizona Arthritis Center, University of Arizona, Tucson
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Baraliakos X, Braun J, Deodhar A, Poddubnyy D, Kivitz A, Tahir H, Van den Bosch F, Delicha EM, Talloczy Z, Fierlinger A. Long-term efficacy and safety of secukinumab 150 mg in ankylosing spondylitis: 5-year results from the phase III MEASURE 1 extension study. RMD Open 2019; 5:e001005. [PMID: 31565244 PMCID: PMC6744073 DOI: 10.1136/rmdopen-2019-001005] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/18/2019] [Indexed: 12/17/2022] Open
Abstract
Objective This study aimed to report end-of-study results on efficacy and safety of secukinumab 150 mg through 5 years in patients with ankylosing spondylitis (AS; MEASURE 1 extension trial (NCT01863732)). Methods After the 2-year core trial, 274 patients receiving subcutaneous secukinumab 150 or 75 mg (following intravenous loading or initial placebo treatment to 16/24 weeks) every 4 weeks were invited to enter the 3-year extension study. Dose escalation from 75 to 150 mg (approved dose) was allowed at or after week 156 based on the judgement of the treating physician. Assessments at week 260 (5 years) included Assessment of SpondyloArthritis international Society (ASAS) 20/40 and other efficacy outcomes. Data are presented as observed. Safety assessment included all patients who received ≥1 dose of study treatment. Results Of the 274 patients who entered the extension study, 84% (230/274) completed 5 years of treatment. ASAS20/40 responses were 78.6/65.2%, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 response was 63.4% and mean (±SD) BASDAI total score was 2.6±1.76 with secukinumab 150 mg at 5 years. Improvements in efficacy outcomes were sustained through 5 years. A total of 82 patients on secukinumab 75 mg (56.2%) had their dose escalated to 150 mg after week 168; ASAS40, ASAS-PR, ASAS 5/6 and BASDAI50 responses were improved in patients whose dose was escalated from secukinumab 75 to 150 mg. Secukinumab was well tolerated with a safety profile consistent over the course of the study. Conclusions Secukinumab 150 mg provided sustained efficacy across multiple domains of AS with a favourable and consistent safety profile through 5-year treatment. Over 50% of patients required dose escalation from 75 to 150 mg and efficacy improved in these patients.
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Affiliation(s)
- Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, Ruhr University Bochum, Bochum, Germany
| | - Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr University Bochum, Bochum, Germany
| | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
| | - Denis Poddubnyy
- Rheumatology department, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alan Kivitz
- Altoona Arthritis & Osteoporosis Center, Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | - Hasan Tahir
- Department of Rheumatology, Barts Health NHS Trust, London, UK
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium.,VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - Evie-Maria Delicha
- Immunology, Hepatology and Dermatology, Novartis Pharma AG, Basel, Switzerland
| | - Zsolt Talloczy
- Immunology, Hepatology and Dermatology, Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
| | - Anke Fierlinger
- Immunology, Hepatology and Dermatology, Novartis Pharmaceuticals Corp, East Hanover, New Jersey, USA
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Kim D, Kim H, Cho S, Park M. A cost per responder analysis of secukinumab vs adalimumab for the treatment of ankylosing spondylitis from the Korean perspective. Int J Rheum Dis 2019; 22:1630-1637. [DOI: 10.1111/1756-185x.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/02/2019] [Accepted: 05/18/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Dam Kim
- Division of Rheumatology, Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Hyojin Kim
- Patient Access Team Novartis Korea Seoul Korea
| | - SeongHa Cho
- Patient Access Team Novartis Korea Seoul Korea
| | - Min‐Chan Park
- Division of Rheumatology, Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
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Pedersen SJ, Maksymowych WP. Beyond the TNF-α Inhibitors: New and Emerging Targeted Therapies for Patients with Axial Spondyloarthritis and their Relation to Pathophysiology. Drugs 2019; 78:1397-1418. [PMID: 30171593 DOI: 10.1007/s40265-018-0971-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Axial spondyloarthritis (axSpA) is a complex disease that affects the joints and entheses of axial and peripheral joints, and is associated with inflammation in extra-articular sites such as the gut. Improved knowledge on genetics and immunology has improved treatment options with the availability of treatments targeting tumor necrosis factor-α (TNF-α) and interleukin (IL)-17. However, these agents do not provide clinical benefit for about 40% of patients, and additional therapeutic options are necessary. Theories on pathogenesis includes misfolding of HLA-B*27 during its assembly leading to endoplasmic reticulum stress and autophagy/unfolded protein response (UPR). HLA-B*27 may express free heavy chain on the cell surface, which activates innate immune receptors on T, natural killer, and myeloid cells with pro-inflammatory effects. Activation of UPR genes is associated with increased TNF-α, interleukin-23 (IL-23), IL-17, interferon-γ expression, and expansion of T helper (Th)-17 cells. Certain genotypes of endoplasmic reticulum aminopeptidase (ERAP) 1 and 2 are associated with ankylosing spondylitis (AS) and functionally interact with the HLA-B27 peptidome. Innate immune cells type 3, which express RORγt, regulate expression of IL-17 and IL-22 in T cells. Stimulation of gamma-delta T cells with IL-23 also induces IL-17. Mucosa-associated invariant T cells residing in the gut mucosa express IL-17 in AS patients after stimulation with IL-7. Prostaglandin E2 induces IL-17A independent of IL-23 via IL-1β and IL-6. The pathogenic role of gut inflammation, zonulin and microbiota, which has a different composition in AS patients, remains to be elucidated. This article also includes a comprehensive review on the mechanism of action and efficacy of the biological treatments currently approved for axSpA (TNF-α inhibitors and IL-17 inhibitors) and future targets for treatment (other IL-17 family member (s), Janus kinase, IL-23, and phosphodiesterase 4).
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Affiliation(s)
- Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
| | - Walter P Maksymowych
- Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2S2, Canada
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Abstract
The triggers and pathogenesis of axial spondyloarthritis (axSpA) are not yet completely understood. However, therapeutic agents targeting tumor necrosis factor-α and interleukin-17 inflammatory pathways have proven successful in suppressing many of the clinical symptoms and signs of axSpA, giving us an indication of which pathways are responsible for initiating and maintaining the inflammation. The mechanisms that eventuate in syndesmophytes and ankyloses are less clear. This review addresses these two critical pathways of inflammation, discussing their nature and these factors that may activate or enhance the pathways in patients with axSpA. In addition, genetic and other markers important to the inflammatory pathways implicated in axSpA are explored, and prognostic biomarkers are discussed. Treatment options available for the management of axSpA and their associated targets are highlighted.
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Affiliation(s)
- Daniel E Furst
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - James S Louie
- Department of Medicine, Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Torgutalp M, Poddubnyy D. IL-17 inhibition in axial spondyloarthritis: current and future perspectives. Expert Opin Biol Ther 2019; 19:631-641. [PMID: 30957574 DOI: 10.1080/14712598.2019.1605352] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Interleukin (IL)-17 is a proinflammatory cytokine considered to play a significant role in the immunopathogenesis of ankylosing spondylitis (AS)/axial spondyloarthritis (axSpA) as well as of other spondyloarthritides. There is a number of substances targeting IL-17, which are at different stages of development in the axSpA indication. AREAS COVERED This review summarizes the current evidence on the role of IL-17 in the pathophysiology of axSpA and provided a comprehensive review of clinical and radiographic outcomes as well as of safety data from studies with IL-17A inhibitors secukinumab and ixekizumab. Ongoing studies on other IL-17 inhibitors (bimekizumab, brodalumab and BCD-085) that are being developed are also summarized. EXPERT OPINION The development of the IL-17 inhibitors has expanded AS treatment with effective options and confirmed the pathophysiological role of IL-17 in axSpA. IL-17 inhibition showed sufficient efficacy against signs and symptoms of the disease even after the failure of tumor necrosis factor inhibitors, being at the same time reasonably safe.
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Affiliation(s)
- Murat Torgutalp
- a Division of Rheumatology, Department of Internal Medicine , Ankara University Faculty of Medicine , Ankara , Turkey.,b Department of Gastroenterology , Infectiology and Rheumatology, Campus Benjamin Franklin, Charité - Universitätsmedizin , Berlin , Germany
| | - Denis Poddubnyy
- b Department of Gastroenterology , Infectiology and Rheumatology, Campus Benjamin Franklin, Charité - Universitätsmedizin , Berlin , Germany.,c Department of Epidemiology , German Rheumatism Research Centre , Berlin , Germany
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Purmonen T, Puolakka K, Mishra D, Gunda P, Martikainen J. Cost-effectiveness of secukinumab compared to other biologics in the treatment of ankylosing spondylitis in Finland. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:159-168. [PMID: 30858713 PMCID: PMC6386207 DOI: 10.2147/ceor.s192235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim This study assesses the cost-effectiveness of secukinumab vs currently licensed biologics for the treatment of ankylosing spondylitis (AS) from the Finnish health care system perspective. Methods A semi-Markov model compared secukinumab with adalimumab, adalimumab biosimilar, certolizumab pegol, etanercept, etanercept biosimilar, golimumab, and infliximab in a biologic-naïve population over a lifetime horizon. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess the treatment response. Efficacy inputs were obtained from the network meta-analysis, and other model inputs were obtained from the published literature and Finnish sources. Main study outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratio in terms of cost per QALY gained. Robustness of results was confirmed by sensitivity analyses and alternative scenario analyses. Results Secukinumab achieved highest QALYs (13.1) at lowest expected lifetime cost (€279,872) vs other comparators in biologic-naïve AS patients in the base case analysis, thus it dominated other biologics. Golimumab had a second highest QALYs (12.9) at the total cost of €309,551. Results were sensitive to variation in BASDAI 50 response for secukinumab, baseline Bath Ankylosing Spondylitis Functional Index (BASFI) score across all drugs, change in BASDAI and BASFI scores, and discount rates as observed in the one-way sensitivity analyses. Secukinumab was either dominant or cost-effective treatment in different alternative scenarios. Conclusion Secukinumab presented itself to be the dominant (ie, less costly and more effective) treatment vs other comparators for the biologic-naïve patients with AS in Finland.
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Affiliation(s)
| | - Kari Puolakka
- South Karelia Central Hospital, Lappeenranta, Finland
| | - Dinesh Mishra
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - Praveen Gunda
- Novartis Product Lifecycle Services-NBS, Novartis Healthcare Private Limited, Hyderabad, India
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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Min HK, Choi J, Lee SY, Seo HB, Jung K, Na HS, Ryu JG, Kwok SK, Cho ML, Park SH. Protein inhibitor of activated STAT3 reduces peripheral arthritis and gut inflammation and regulates the Th17/Treg cell imbalance via STAT3 signaling in a mouse model of spondyloarthritis. J Transl Med 2019; 17:18. [PMID: 30630513 PMCID: PMC6329133 DOI: 10.1186/s12967-019-1774-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/04/2019] [Indexed: 01/03/2023] Open
Abstract
Background Spondyloarthritis (SpA) is chronic inflammatory arthritis, and interleukin (IL)-17 is crucial in SpA pathogenesis. Type 17 helper T (Th17) cells are one of major IL-17-secreting cells. Signal transducer and activator of transcription (STAT)-3 signaling induces Th17 differentiation. This study investigated the effects of protein inhibitor of activated STAT3 (PIAS3) on SpA pathogenesis. Curdlan was injected into SKG ZAP-70W163C mice for SpA induction. Methods The PIAS3 or Mock vector was inserted into mice for 10 weeks. Clinical and histologic scores of the paw, spine, and gut were evaluated. The expression of IL-17, tumor necrosis factor-α (TNF-α), STAT3, and bone morphogenic protein (BMP) was measured. Confocal microscopy and flow cytometry were used to assess Th cell differentiation. Results PIAS3 significantly diminished the histologic scores of the paw and gut. PIAS3-treated mice displayed decreased expression of IL-17, TNF-α, and STAT3 in the paw, spine, and gut. BMP-2/4 expression was lower in the spines of PIAS3-treated mice. Th cell differentiation was polarized toward the upregulation of regulatory T cells (Tregs) and the downregulation of Th17 in PIAS3-treated mice. Conclusion PIAS3 had beneficial effects in mice with SpA by reducing peripheral arthritis and gut inflammation. Pro-inflammatory cytokines and Th17/Treg differentiation were controlled by PIAS3. In addition, BMPs were decreased in the spines of PIAS3-treated mice. These findings suggest that PIAS3 could have therapeutic benefits in patients with SpA.
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Affiliation(s)
- Hong-Ki Min
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 137-070, South Korea.,Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - JeongWon Choi
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - Seon-Yeong Lee
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - Hyeon-Beom Seo
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - KyungAh Jung
- Impact Biotech, Korea 505 Banpo-Dong, Seocho-Ku, Seoul, 137-040, South Korea
| | - Hyun Sik Na
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea.,Laboratory of Immune Network, Conversant Research Consortium in Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jun-Geol Ryu
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 137-070, South Korea.,Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea
| | - Mi-La Cho
- Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea. .,Laboratory of Immune Network, Conversant Research Consortium in Immunologic Disease, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,Rheumatism Research Center, Catholic Institutes of Medical Science, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 137-701, South Korea.
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 137-070, South Korea. .,Rheumatism Research Center, Catholic Research Institute of Medical Science, The Catholic University of Korea, Seoul, 137-040, South Korea. .,Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-Daero, Seocho-gu, Seoul, 137-701, South Korea.
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62
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Dubash S, Bridgewood C, McGonagle D, Marzo-Ortega H. The advent of IL-17A blockade in ankylosing spondylitis: secukinumab, ixekizumab and beyond. Expert Rev Clin Immunol 2019; 15:123-134. [DOI: 10.1080/1744666x.2019.1561281] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sayam Dubash
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Dennis McGonagle
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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63
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Wendling D, Verhoeven F, Prati C. Anti-IL-17 monoclonal antibodies for the treatment of ankylosing spondylitis. Expert Opin Biol Ther 2018; 19:55-64. [DOI: 10.1080/14712598.2019.1554053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel Wendling
- Department of Rheumatology, CHRU de BESANCON, University Teaching Hospital, Besançon, France
- Université Bourgogne Franche-Comté, Besançon, France
| | - Frank Verhoeven
- Department of Rheumatology, CHRU de BESANCON, University Teaching Hospital, Besançon, France
| | - Clément Prati
- Department of Rheumatology, CHRU de BESANCON, University Teaching Hospital, Besançon, France
- Université Bourgogne Franche-Comté, Besançon, France
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The Management of Acute Anterior Uveitis Complicating Spondyloarthritis: Present and Future. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9460187. [PMID: 30406148 PMCID: PMC6204187 DOI: 10.1155/2018/9460187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022]
Abstract
Spondyloarthropathies (SpA) encompass a group of chronic inflammatory diseases sharing common genetic and clinical features, including the association with HLA-B27 antigen, the involvement of both the axial and the peripheral skeleton, the presence of dactylitis, enthesitis, and typical extra-articular manifestations such as psoriasis, inflammatory bowel disease, and acute anterior uveitis (AAU). The latter is commonly reported as a noninfectious acute inflammation of the anterior uveal tract and its adjacent structures. AAU may affect more than 20% of SpA patients representing the most common extra-articular manifestation of the disease. Considering the potential consequences of untreated AAU, early diagnosis and aggressive treatment are crucial to avoid complications of remittent or chronic eye inflammation, such as visual loss and blindness. The management of SpA has dramatically improved over the last decades due to the development of new treat-to-target strategies and to the introduction of biologic disease modifying antirheumatic drugs (bDMARDs), particularly tumor necrosis factor alpha inhibitors (TNFis), currently used for the treatment of nonresponder patients to conventional synthetic agents. Along with the improvement of musculoskeletal features of SpA, bDMARDs provided an additional effect also in the management of AAU in those patients who are failures to topical and systemic conventional therapies. Nowadays, five TNFis, one interleukin-17, and one interleukin 12/23 blocker are licensed for the treatment of SpA, with different proven efficacy in preventing and treating ocular involvement. The aim of this review is to summarize the current options and to analyze the future perspectives for the management of SpA-associated AAU.
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Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res 2018; 7. [PMID: 30345001 PMCID: PMC6173104 DOI: 10.12688/f1000research.14956.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 12/14/2022] Open
Abstract
The term spondyloarthritis refers to a group of immune-mediated diseases characterised by inflammation of the axial skeleton, peripheral joints, and entheses. Ankylosing spondylitis (AS) is the most common and characteristic of these entities and even though it was first described over two centuries ago, the understanding of the underlying disease mechanism remains incomplete. It is known that around 40% of patients with AS have subclinical bowel inflammation, suggesting that the origin of the disease could be in the gut. Also, more genes and new molecules have demonstrated a role in the pathogenesis of AS. In this review, we analyse the latest therapies for spondyloarthritis and the most relevant discoveries over the last three years, together with their implications for different aspects of the disease.
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Affiliation(s)
- Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Hanna Gul
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.,NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Garcia-Montoya L, Marzo-Ortega H. The role of secukinumab in the treatment of psoriatic arthritis and ankylosing spondylitis. Ther Adv Musculoskelet Dis 2018; 10:169-180. [PMID: 30210583 DOI: 10.1177/1759720x18787766] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/15/2018] [Indexed: 01/13/2023] Open
Abstract
Psoriatic arthritis and ankylosing spondylitis are chronic inflammatory diseases that can cause significant disability. The commercialization of the first tumour necrosis factor (TNF) inhibitors led to a radical improvement of the quality of life of people affected by these conditions; however, response was not universal, highlighting the need for alternative therapeutic targets. Secukinumab is a monoclonal interleukin (IL)-17A inhibitor which has been proven efficacious for psoriatic arthritis and ankylosing spondylitis in recent clinical trials. Dactylitis, enthesitis, skin and nails are some of the domains in which the inhibition of IL-17 has shown significant improvements apart from the joints. Its safety profile and satisfactory medium- to long-term outcome data are some of the aspects suggesting its potential impact in treatment protocols in the short term.
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Affiliation(s)
| | - Helena Marzo-Ortega
- LIRMM, University of Leeds, Second floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
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Efficacy and Safety of Secukinumab 150 mg with and Without Loading Regimen in Ankylosing Spondylitis: 104-week Results from MEASURE 4 Study. Rheumatol Ther 2018; 5:447-462. [PMID: 30121827 PMCID: PMC6251842 DOI: 10.1007/s40744-018-0123-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION To evaluate the efficacy and safety of secukinumab 150 mg, with or without a loading regimen, using a self-administered prefilled syringe in patients with ankylosing spondylitis (AS) over 104 weeks from the MEASURE 4 study. METHODS Patients (N = 350) with active AS were randomized (1:1:1) to receive subcutaneous secukinumab 150 mg with loading dose (150 mg), without loading dose (150 mg no load), or placebo. All patients received secukinumab or placebo at baseline, weeks 1, 2, and 3 and every 4 weeks starting at week 4. The primary endpoint was the Assessment of SpondyloArthritis international Society criteria for 20% improvement (ASAS20) at week 16. RESULTS A total of 96.9% of patients (339/350) completed 16 weeks and 82.6% (289/350) completed 104 weeks of treatment. The ASAS20 response rate at week 16 was 59.5% and 61.5% with 150 and 150 mg no load groups, respectively, versus placebo (47%; P = 0.057 and 0.054, respectively); the primary endpoint was not met. Increases in response rates achieved with secukinumab for ASAS20 at week 16 were sustained through week 104. The safety profile of secukinumab 150 mg, with or without a loading regimen, showed no new or unexpected safety signals. CONCLUSIONS Secukinumab 150 mg, with or without loading regimen, provided rapid and sustained decreases in the signs and symptoms of patients with AS, but the differences were not statistically significant at week 16 due to higher than expected placebo responses. The responses and safety profile were consistent with previous phase 3 studies and sustained through 2 years. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02159053. FUNDING Novartis Pharma AG, Basel, Switzerland.
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Abstract
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA. Newer biologic agents, such as those targeting the interleukin 17-interleukin 23 axis, have promising efficacy and may improve HRQoL for patients with AxSpA. The AxSpA has many negative effects on HRQoL. By targeting disease pathways responsible for the development of AxSpA, approved and emerging therapies potentially reduce disease activity and improve the functional status of patients with AxSpA. This narrative review reflects on the findings of studies evaluating HRQoL of individuals with AxSpA and the role of newer therapies.
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Actualisation 2018 des recommandations de la Société française de rhumatologie (SFR) pour la prise en charge en pratique courante des malades atteints de spondyloarthrite. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rhum.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wendling D, Lukas C, Prati C, Claudepierre P, Gossec L, Goupille P, Hudry C, Miceli-Richard C, Molto A, Pham T, Saraux A, Dougados M. 2018 update of French Society for Rheumatology (SFR) recommendations about the everyday management of patients with spondyloarthritis. Joint Bone Spine 2018; 85:275-284. [PMID: 29407043 DOI: 10.1016/j.jbspin.2018.01.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update French Society for Rheumatology recommendations about the management in clinical practice of patients with spondyloarthritis (SpA). SpA is considered across the range of clinical phenotypes (axial, peripheral, and entheseal) and concomitant manifestations. Psoriatic arthritis is included among the SpA phenotypes. METHODS According to the standard procedure advocated by the EULAR for developing recommendations, we first reviewed the literature published since the previous version of the recommendations issued in June 2013. A task force used the results to develop practice guidelines, which were then revised and graded using AGREE II. RESULTS Four general principles and 15 recommendations were developed. The first four recommendations deal with treatment goals and general considerations (assessment tools and comorbidities). Recommendations 5 and 6 are on non-pharmacological treatments. Recommendation 7 is about nonsteroidal anti-inflammatory drugs, which are the cornerstone of the treatment, and recommendations 8 to 10 are on analgesics, glucocorticoid therapy, and conventional disease-modifying antirheumatic drugs. Biologics are the focus of recommendations 11 through 14, which deal with newly introduced drug classes, including their indications (active disease despite conventional therapy and, for nonradiographic axial SpA, objective evidence of inflammation) and monitoring, and with patient management in the event of treatment failure or disease remission. Finally, recommendation 15 is about surgical treatments. CONCLUSION This update incorporates recent data into a smaller number of more simply formulated recommendations, with the goal of facilitating their use for guiding the management of patients with SpA.
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Affiliation(s)
- Daniel Wendling
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4266, université Bourgogne Franche-Comté, place Goudimel, 25030 Besançon, France.
| | - Cédric Lukas
- EA2415, département de rhumatologie, institut universitaire de recherche clinique, université de Montpellier, CHU de Lapeyronie, 34000 Montpellier, France
| | - Clément Prati
- Service de rhumatologie, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA4267, FHU Increase, université Bourgogne Franche-Comté, 25030 Besançon, France
| | - Pascal Claudepierre
- Service de rhumatologie, groupe hospitalier Henri-Mondor, AP-HP, Créteil, 94000, France; EA 7379-épiderme, université Paris Est Créteil, Créteil, 94000, France
| | - Laure Gossec
- UPMC universié Paris 06, Sorbonne universités, institut Pierre-Louis d'épidémiologie et de santé publique (UMRS 1136), 75252 Paris, France; Rheumatology department, hôpital Pitié Salpêtrière, AP-HP, 75013 Paris, France
| | - Philippe Goupille
- Service de rhumatologie, CHRU de Tours, 37000 Tours, France; UMR CNRS 7292, université François-Rabelais, 37000 Tours, France
| | - Christophe Hudry
- Cabinet de rhumatologie, 75008 Paris, France; Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Corinne Miceli-Richard
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France
| | - Anna Molto
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
| | - Thao Pham
- Service de rhumatologie, hôpital Sainte-Marguerite, Aix-Marseille université, AP-HM, 13000 Marseille, France
| | - Alain Saraux
- Service de rhumatologie, CHU de Brest, 29609 Brest cedex, France; UMR1227, université de Bretagne Occidentale, labex IGO, Brest, 29000 France
| | - Maxime Dougados
- Paris Descartes university, department of rheumatology, hôpital Cochin, AP-HP, EULAR center of excellence, 75014 Paris, France; INSERM (UU1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris 14, France
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Marzo-Ortega H, Sieper J, Kivitz A, Blanco R, Cohen M, Delicha EM, Rohrer S, Richards H. Secukinumab provides sustained improvements in the signs and symptoms of active ankylosing spondylitis with high retention rate: 3-year results from the phase III trial, MEASURE 2. RMD Open 2017; 3:e000592. [PMID: 29435364 PMCID: PMC5761290 DOI: 10.1136/rmdopen-2017-000592] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022] Open
Abstract
Background Secukinumab treatment has previously been shown to significantly improve the signs and symptoms of active ankylosing spondylitis (AS), with responses sustained through 2 years. Here, we report the long-term (3 years) efficacy and safety of secukinumab in the MEASURE 2 study. Methods MEASURE 2 (NCT01649375) is a 5-year phase III, randomised, double-blind, double-dummy, parallel-group, placebo-controlled study to evaluate the efficacy, safety and tolerability of subcutaneous loading and maintenance dosing of secukinumab in adult subjects with active AS. Subjects were randomised to receive subcutaneous secukinumab 150 mg, 75 mg or placebo at baseline, weeks 1, 2 and 3 and every 4 weeks from week 4. At week 16, placebo-treated subjects were rerandomised to receive secukinumab 150/75 mg. Results Retention rates were high during weeks 16–156 and were 86% and 76% for secukinumab 150 and 75 mg, respectively. Secukinumab 150 mg provided sustained improvements in the Assessment of Spondyloarthritis International Society ASAS 20/40 response rates at week 156 (70.1%/60.9%) compared with week 52 (74.2%/57.0%); however, there was a slight decrease for secukinumab 75 mg (54.3%/37.0% vs 62.5%/43.2%, respectively). Sustained improvements were observed in all other end points, including Bath Ankylosing Spondylitis Disease Activity Index, AS Disease Activity Score with C reactive protein inactive disease, ASAS 5/6, Short Form-36 Physical Component Summary and ASAS partial remission. Clinical benefits were observed regardless of prior exposure to anti-tumour necrosis factor agents. The safety profile remained favourable and was consistent with previous reports. Conclusions This study showed sustained improvement through 3 years in signs, symptoms and physical function in subjects with AS. Retention rates were high and secukinumab was well tolerated, with a favourable safety profile.
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Affiliation(s)
- Helena Marzo-Ortega
- Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, Pennsylvania, USA
| | - Ricardo Blanco
- Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
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Th17 cell responses in spondyloarthritis. Best Pract Res Clin Rheumatol 2017; 31:777-796. [DOI: 10.1016/j.berh.2018.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
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Deodhar A, Yu D. Switching tumor necrosis factor inhibitors in the treatment of axial spondyloarthritis. Semin Arthritis Rheum 2017; 47:343-350. [PMID: 28551170 DOI: 10.1016/j.semarthrit.2017.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the impact of switching tumor necrosis factor (TNF)-alpha inhibitors on patients with axial spondyloarthritis (axSpA). METHODS PubMed literature searches were conducted using combinations of search terms including ankylosing spondylitis, spondyloarthropathy, spondyloarthritis, switch/switching, drug survival, and TNF/tumor necrosis factor to identify published articles with data on outcomes related to switching biologic therapies in patients with axSpA. RESULTS Of the 134 studies screened, 21 were identified as reporting data on switching TNF inhibitors in patients carrying a diagnosis of axSpA or ankylosing spondylitis. The most common reasons for switching from the first TNF inhibitor were lack of efficacy (14-68%), loss of efficacy (13-61%), and adverse events/poor tolerability (13-57%). Switching TNF inhibitors was beneficial for a substantial proportion of patients with axSpA who failed to respond to initial or even second TNF inhibitor therapy and adverse effects were not enhanced. Drug survival rates were generally lower for the second (47-72% at 2 years) or third TNF inhibitor (49% at 2 years) than for the first TNF inhibitor (58-75% at 2 years). Predictors of responses in TNF-naïve patients included HLA-B27 positivity, absence of enthesitis, age ≤40 years, elevated C-reactive protein level, good functional status, and shorter disease duration. Predictors of drug survival included male sex and peripheral arthritis. Common characteristics of patients who switched TNF inhibitors included female sex, older age, more severe disease, greater symptom burden, higher erythrocyte sedimentation rate, complete ankyloses, and enthesitis. CONCLUSION When the first or even the second TNF inhibitor fails, switching to an alternate one is not an unreasonable clinical therapeutic decision.
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Affiliation(s)
- Atul Deodhar
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97299.
| | - David Yu
- Ronald Reagan UCLA Medical Center, Los Angeles, CA
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