Real-World Data: Psoriatic Arthritis Patients Stay on Cosentyx After Other Options Fail

Cosentyx (secukinumab) has a high persistence rate among patients with psoriatic arthritis (PsA) who are familiar with biologic medications, according to a real-world study of patients treated in outpatient rheumatology clinics in Greece. The findings were published in the journal Frontiers in Medicine.

The biologic, a recombinant human monoclonal antibody that targets interleukin-17A, was approved for the treatment of PsA in Europe in 2015, and in the United States in 2016.

Investigators wanted to know whether patients with PsA would stick with Cosentyx if they had already tried another biologic; this measure, called persistence, is important to payers because many do not want to start patients on costlier branded medications if the patient abandons use and receives little or no benefit.

The study involved 75 patients who had previously been treated with another biologic. Almost two-thirds (64%) had received anti-tumor necrosis factor (TNF) drugs, such as Humira (adalimumab); 7% had received the anti-IL12/23 Stelara (ustekinumab), and 29% had tried both. During the study, half the patients receiving Cosentyx also received non-biologics (53%), and a third (35%) received glucocorticoids.

About three-quarters of the patients were women (76%), with a mean age of 54 years. They had lived with PsA for 6.7 years, with a median treatment time of 11.1 months on Cosentyx. Patients had follow-up visits every three to six months from March 2016 to December 2018.

At the start of the study, the patients had the following symptoms:

• 97% had peripheral arthritis
• 42% had axial involvement
• 22% had enthesitis, involving inflammation where the tendon meets the bone
• 12% had dactylitis, a swollen, painful inflammation of the fingers

Treatment with Cosentyx brought statistically significant improvements in all these symptoms, as measured both by disease activity indexes and functionality scores. Dactylitis resolved for the patients who reported it, and enthesitis resolved for more than half (56%) who had this at baseline.

At the end of the study’s follow-up period, peripheral arthritis scores improved, as did patients’ function scores, which were assessed by questionnaire. All patients with dactylitis at baseline saw the symptom resolve, as did 56% of patients with enthesitis at baseline.

In their paper, the authors say a “novel finding” of the study is the data for patients treated with Cosentyx who had previously received both anti-TNF agents and anti-IL12/23 agents.

Persistence
Referred to by the authors as “drug survival,” the rate at the last follow-up visit was 64%, with an estimated median drug survival of 26.8 months. The estimated 1 and 2 years drug survival was 66% and 56%, respectively, the authors wrote.

“In our study, the overall [Cosentyx] survival of patients exposed to both classes was not different from those exposed to anti-TNFs alone (68% vs. 67%),” they said.

The authors say their evidence lends support the idea that Cosentyx can help patients for whom other treatments have failed. “Our findings suggest that (Cosentyx) is an efficacious and well-tolerated biologic agent in this multi-resistant, difficult to treat patient group,” they said.