Background/Purpose: Musculoskeletal changes precede the onset of psoriatic arthritis (PsA). A subset of psoriasis patients is characterized by arthralgia as well as inflammatory changes in the joints visible by MRI assessment. These patients have a high risk to progress into PsA. The objective of the study was to test the concept of a very early intervention in PsA we exposed psoriasis patients with subclinical joint inflammation to the anti-interleukin (IL)-17A antibody secukinumab. We hypothesized that IL-17A inhibition disrupted the early link between skin and joint disease in Psoriasis.

Methods: Psoriasis (but not PsA) patients were included in the open prospective 24-weeks “Interception in Very Early PSA” (IVEPSA) study. To fulfill the inclusion criteria patients had to have a PASI score greater than 6 or nail or scalp involvement as well as inflammatory or erosive changes in MRI or high-resolution peripheral quantitative computed tomography (HRpQCT) at baseline. Patients received treatment with secukinumab 300 mg sc. for 24 weeks. MRI scans and HRpQCT of the dominant hand were performed at baseline and at 24 weeks. MRI was scored according to PsAMRIS. HRpQCT evaluated for erosions and enthesiophytes.

Results:

20 patients (median age 49.5 years (IQR 42.8, 59), 70% males) with a median disease duration of 14 years (IQR 5, 20), were included into the study. At baseline, 85% reported arthralgia assessed by a Visual Analogue Scale (VAS) and 40% had tender joints on examination (TJC78). 83.3% had at least one inflammatory lesion in the MRI, 66.7% synovitis, 55.6% tendinitis/enthesitis, 27.8% osteitis and 16.7% periarticular inflammation. Erosions were present in 72.2% and 58.8% in the MRI and HRpQCT, respectively, while enthesiophytes were found in 33.3% and 41.2%. One patient was discontinued early due to lack of improvement (wk12) and one patient was unable to perform the follow-up MRI. Psoriatic skin disease (total PASI and BSA) significantly improved (both p<0.05) and also arthralgia (VAS pain, tender joint count) significantly declined after secukinumab treatment (both p<0.05). Total PsAMRIS score and synovitis subscore significantly improved at wk24 (p=0.005 and p=0.008, respectively). Importantly, improvement in total PsAMRIS score significantly correlated with the improvement in arthralgia (p<0.05). Finally, neither erosions nor enthesiophytes in MRI and HRpQCT progressed during the 24 weeks of treatment. There was no new safety signal in the study.

Conclusion:

IL-17 inhibition by secukinumab over 24 weeks led to resolution of inflammation and no progression of bone changes in the joints in psoriasis patients with subclinical peripheral joint involvement. These data suggest that very early disease interception in PsA is a feasible approach. IVEPSA also provides the guide for further very early interventions in PsA providing concepts for imaging-based identification and the sensitivity to change of subclinical inflammation to biological disease modifying anti-rheumatic drug therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-interception-in-psoriasis-patients-with-subclinical-joint-inflammation-by-interleukin-17-inhibition-with-secukinumab-data-from-a-prospective-open-label-study/