SAT0428 IMPACT OF DOSE ESCALATION OF SECUKINUMAB IN PATIENTS WITH PSORIATIC ARTHRITIS IN REAL-WORLD SETTING.
Authors: M. Martin Lopez, B. Joven-Ibáñez, J. L. Pablos
Journal: Annals of the Rheumatic Diseases (2020)

Background: Secukinumab (SEC) has provided efficacy in clinical trials in patients with psoriatic arthritis (PsA). In PsA patients, a gain in response has been suggested by dose escalation from 150 to 300 mg in the open phase of the FUTURE study 1 . Objectives: To analyze the usefulness of dose escalation of SEC from 150 to 300 in patients with non-responding PsA to 150 mg in real-world setting. Methods: Multicentric observational, longitudinal, retrospective study conducted in a tertiary hospital between January 2016 and December 2019. Patients with PsA (CASPAR criteria) receiving at least one dose of SEC were included. Medical records were reviewed to collect demographic and clinical data related to PsA (including activity assessment and treatment). Descriptive statistics and a comparative analysis of the efficacy of SCK by the Student t test in the different dose groups and by the ANOVA test to compare the response between the three dose groups were performed. Results: 98 patients with PsA treated with SEC, of which 69(70%) female were included. Mean age was 54 y.o (SD12) and average duration of the disease was 9 (SD 7) years. Three groups were made according to the dose received, SEC150, SEC300 and SEC150-300 (non-responders after SEC150 onset increasing to 300 mg). The SEC150 group includes 58(59%) patients of whom 32(55%) had received at least one biological (16 one biological, 8 two biological and 10 three or more). The survival of SEC was 1.3 (SD1) years and was suspended in 24(41%) patients, due to primary failure in 9, secondary failure 10, adverse events 4 and allergy to latex 1. The SEC300 group includes 12 (12%) patients of whom 10 (83%) had received at least one biological (1 one biological, 3 two and 6 three or more). The survival of the SEC was 1.6 SD (1.3) years and was suspended in 8 (67%) patients, due to primary failure in 2, secondary failure 5 and remission 1. Finally, the SEC150-300 group includes 28 (29%) patients of whom 17 (61%) had received at least one biologic (7 one biologic, 2 two and 8 three or more). The survival of the SEC was 1.6 (SD0.9) years and was suspended in 13 (46%) patients, all due to secondary failure. 54%, therefore, maintains the SCK after responding to the dose increase. The average time of dose increase to 300 mg was 9(SD6) months. In the three treatment groups, a significant decrease in the values of CRP, ASDAS-CRP and DAPSA was observed at 6 months of SEC (Table 1). However, when comparing the difference of means obtained during follow-up (ΔCRP, ΔASDAS and ΔDAPSA) between the 3 dose groups, no significant differences were found (p=0.76 for CRP, p=0.86 for ASDAS and p=0.35 for DAPSA). Table 1. Disease activity assessment at 6 months of SEC therapy. Baseline 6 months after SEC Mean difference p value CRP300 (mg/L) 9±8,3 4,7±3,7 -4,3 (IC95% -8,9 a 0,2) p=0,06 CRP150 (mg/L) 7,3±9,1 4,0±4,7 -2,9 (IC95% -4,7 a -1,3) p=0,0009 CRP150-300(mg/L) 9,9±11 6,0±7,4 -3,9 (IC95% -6,9 a -8,5) p=0,0142 ASDAS-CRP300 2,3±0,7 1,6±0,6 -0,6 (IC95% -0,9 a -0,3) p=0,0014 ASDAS-CRP150 2,3±0,6 1,6±0,7 -0,7 (IC95% -0,8 a -0,5) p&lt;0,0001 ASDAS-CRP150-300 2,2±0,6 1,6±0,7 -0,6 (IC95% -0,8 a -0,4) p&lt;0,0001 DAPSA300 33,7±19,3 16,9±10,6 -16,8 (IC95% -29,6 a -3,9) p=0,01 DAPSA150 27,4±11,4 15,4±10,4 -11 (IC95% -14,4 a -7,6) p&lt;0,0001 DAPSA150-300 28±9,9 15,8±8,7 -12,2 (IC95% -15,3 a -9,1) p&lt;0,0001 CRP300: C-reactive protein in patients with SCK 300 mg, CRP150: in patients with SCK 150, CRP150-300: in patients with dose escalation from 150 to 300 (same for ASDAS-CRP and DAPSA), SEC: secukinumab Conclusion: There are no significant differences in the response evaluated by CRP, ASDAS-CRP and DAPSA between the dose of 150 and 300 mg of SEC. However, both doses of treatment provided efficacy in clinical practice with significant reduction of activity parameters. In the case of patients not responding to SEC150 mg and prior failure to TNFi, increasing the dose to 300 mg could be an effective option. References: [1]Mease PJ, et al. ACR Open Rheum.2020 Jan;2(1):18-25. Disclosure of Interests: MARIA MARTIN LOPEZ: None declared, Beatriz Joven-Ibáñez Speakers bureau: Abbvie, Celgene, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, José Luis Pablos: None declared