Background Moderate to severe psoriasis is considered a multisystem disease that is associated with the risk of other comorbidities complex inflammatory disease. Psoriatic arthritis (PsA) is a form of chronic arthritis associated with psoriasis.
Secukinumab is a monoclonal antibody that blocks the actions of IL-17A.
Purpose To describe the use of the treatment with secukinumab in moderate to severe plaque psoriasis and PsA in clinical practice.
Material and methods A retrospective, longitudinal study was conducted at a tertiary hospital. We included patients with moderate to severe psoriasis and/or PsA treated with secukinumab for at least 12 weeks,from December 2015 to September 2017. We created a database that included sociodemographic (age, sex and weight) and pharmacotherapheutic variables (diagnosis date, first biologic therapy (BT) date, previous and concurrent treatments, initial and current Psoriasis Area and Severity Index (PASI) and changes from baseline in the 28-joint Disease Activity Score on the basis of levels of C-reactive protein (DAS28-CRP)). Data were collected from electronic prescriptions (Prescriplant®) and clinical histories. Effectiveness was evaluated with PASI75 (psoriasis) and DAS28-CRP (≤2.6 remission) (PsA). Adverse reactions were recorded during the follow-up period as a safety measurement.
Results Thirty-two patients were included (median age=49.6 years, 53% males, median weight=87.5 kg). Indications for use were PsA in 14/32 patients (44%) and psoriasis in 18/32 patients (56%). Before using BT, patients were treated with other systemic drugs (median=3 drugs), mostly: phototherapy (77%), methotrexate (77%), cyclosporine (73%) and acitretin (50%) in plaque psoriasis, and methotrexate (90%), sulfasalazine (40%) or leflunomide (30%) in PsA. They received the first BT at a median of 7.5 years (IQR 12.7) after the diagnosis of the disease. Previous BT were mostly: etanercept (47%), adalimumab (41%), ustekinumab (28%) and infliximab (28%). They received secukinumab 300 mg/month (150 mg in five patients with PsA) by subcutaneous injection. Patients had been treated for 9.4 months (IQR 12.6). The median initial PASI was 13.8 (IQR 4.6) and DAS28-CRP was 3.2 (IQR 2.2). Eighty-eight per cent of patients achieved PASI75, final PASI was 0.6 (IQR 2.4) and DAS28-CRP at the end was 2.1 (IQR 2.15). One patient discontinued the treatment because of disease relapse. Nine patients suffered from adverse effects: candidiasis, pharyngitis, arthralgia, high fever and headache.
Conclusion Secukinumab constitutes an effective treatment for patients who failed other BT. Eighty-eight per cent of patients reached PASI75 and DAS28-CRP achieved 2.1 values. Side-effects were moderate and similar to other BTs.
No conflict of interest
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