Background/Purpose: Patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) may suffer from extraarticular (EA) manifestations (uveitis, psoriasis) and have higher rates of comorbidities like cardiovascular diseases (CVD) and depression than the normal population. Comorbidities should be kept in mind when managing patients with PsA and AS, as they can contribute to increased mortality and influence disease activity¹. The aim of this interim analysis is to evaluate the incidence of selected EA manifestations and comorbidities at baseline and the impact of secukinumab on the status of these attributes compared to baseline.

Methods: The presence and severity of uveitis and psoriasis as well as coronary heart disease (CHD), stroke, heart insufficiency, and depression were documented according to clinical routine at baseline and at week 4, 16, 24 and 52 under treatment with secukinumab. Depressed mood has been evaluated by Becks Depression Inventory (BDI-II), plaque psoriasis via PASI score. At baseline 486 patients were included and observed up to 52 weeks, at the time of analysis not all patients have already reached the end of the study, therefore the results are presented as observed.

Results:

As expected, plaque psoriasis was very frequent in PsA patients (63.3%), but also present in AS patients (11.5%) at baseline. For PsA patients, median PASI improved from 5.0 at baseline to 0.0 at week 52. Half of patients with available PASI achieved clear skin at week 52 (Tab 1).

Uveitis was more frequent in AS patients than in PsA patients (6.2% vs 0.9%). Only 1 AS patient and 2 PsA patients experienced new onset of uveitis.

At baseline, the following patients reported previous CHD (PsA 8.9%, AS 3.5%), heart failure (PsA 3.3%, AS 0.7%) and stroke (PsA 2.4%, AS 0.0%). Of these cardiovascular comorbidities none worsened (as observed at each scheduled visit) with secukinumab treatment for all patients observed up to 52 weeks. During the study two PsA patients were newly diagnosed with CHD and heart insufficiency throughout week 52. No new stroke occurred.

Depression was common in both populations (PsA 15.4%, AS 12.2%) at baseline. Up to week 52 median BDI-II improved from 12.0 to 6.0 (AS patients) and from 9.0 to 6.0 (PsA patients [Tab 1]).

Conclusion: Incidence of CVD and depression in PsA and AS patients is generally comparable to the published literature^2,3. However, in contrast to other studies⁴, previous uveitis was less frequently reported in SpA patients, particularly in the AS group. Cardiovascular comorbidities remained overall stable under secukinumab up to wk 52. Plaque psoriasis and depressive mood improved with secukinumab treatment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-secukinumab-study-in-ankylosing-spondylitis-and-psoriatic-arthritis-comorbidities-and-extraarticular-manifestations-incidence-and-status-throughout-a-non-interventional-study-in/