Psoriatic Arthritis
Conditions
Keywords
Psoriatic Arthritis, secukinumab, adalimumab, monoclonal antibody, CASPAR
Brief summary
This was a randomized, double-blind, active controlled, multicenter, parallel-group study evaluating secukinumab monotherapy and adalimumab monotherapy in approximately 850 patients with active psoriatic arthritis (PsA) who are naïve to biologic therapy and are intolerant or having inadequate response to conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs).
Detailed description
The total maximum study duration, including the screening period was up to 76 weeks. At Baseline, patients whose eligibility was confirmed were randomized to 1 of 2 groups (1:1): Group 1 (secukinumab 300 mg) or Group 2 (adalimumab 40 mg). In order to maintain the blind, both groups received 1 or 2 placebo s.c. injections to keep consistency in the number of injections at each dosing visit. Secukinumab (300 mg) was available in 2 x 1.0 mL pre-filled syringes (PFS) and adalimumab was available in 1 x 0.4 mL PFS. Placebo (1.0 and 0.5 mL PFS) was also available. Secukinumab 300 mg s.c injection (2 x 1 mL PFS) was administered at Baseline, Weeks 1, 2, 3 and 4, followed by dosing every 4 weeks to Week 48. Adalimumab 40 mg (1 x 0.4 mL PFS) was administered at Baseline followed by dosing every 2 weeks until Week 50.
Interventions
Eligible subjects are randomized to one of two treatment arms in a 1:1 ratio
Eligible subjects are randomized to one of two treatment arms in a 1:1 ratio
Sponsors
Study design
Eligibility
Inclusion criteria
Key Inclusion Criteria: * Diagnosis of PsA classified by CASPAR * Rheumatoid factor and anti-CCP antibodies negative * Diagnosis of active plaque psoriasis, with at least one psoriatic plaque of \>= 2cm diameter or nail changes consistent with psoriasis or documented history of plaque psoriasis * Inadequate control of symptoms with NSAIDs * Inadequate control of symptoms with a conventional DMARD. Key
Exclusion criteria
* Pregnant or nursing women * Evidence of ongoing infectious or malignant process * Previous exposure to any biologic drug for Psoriatic Arthritis or Psoriasis * Subjects taking high potency opioid analgesics * Ongoing use of prohibited psoriasis treatments/medications * Previous treatment with any cell-depleting therapies including but not limited to anti-CD20 investigational agents.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52 | Week 52 | Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The primary endpoint is the proportion of patients with monotherapy ACR20 response at Week 52 where monotherapy ACR20 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 20 (ACR20) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 50 (the last dosing visit) 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52 | Week 52 | The PASI is a system used for assessing and grading the severity of psoriatic lesions. In the PASI system, the body is divided into 4 regions: the head, trunk, upper extremities, and lower extremities. Each of these areas were assessed separately for the percentage of the area involved, which translates to a numeric score that ranges from 0 to 6, and for erythema, induration, and scaling, which are each rated on a scale of 0 to 4. The PASI produces a numeric score that can range from 0 to 72. A higher score indicates more severe disease. A PASI 90 response represents participants who achieved at least a 90 percent improvement from baseline in the PASI score. |
| Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52 | Week 52 | Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The secondary endpoint is the proportion of patients with monotherapy ACR50 response at Week 52 where monotherapy ACR50 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 50 (ACR50) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 52 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs) |
| Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52 | Baseline, Week 52 | The HAQ-DI assesses a subject's level of functional ability and includes questions of fine movements of the upper extremity, locomotor activities of the lower extremity, and activities that involve both upper and lower extremities. There are 20 questions in 8 categories of functioning including dressing, rising, eating, walking, hygiene, reach, grip and usual activities. The stem of each item asks 'Over the past week, are you able to... perform a particular task'. Each item is scored on a 4 point scale from 0 - 3, representing normal, no difficulty (0), some difficulty (1), much difficulty (2) and unable to do (3). The disability index score is calculated as the mean of the available category scores, ranging from 0 to 3. A negative change from baseline indicates improvement. |
| Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52 | Week 52 | Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Resolution was defined as the absence of recorded enthesitis; conducted by the study assessor. |
Countries
Australia, Bulgaria, Canada, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Israel, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Russia, Slovakia, South Korea, Spain, United Kingdom, United States
Participant flow
Recruitment details
This study was conducted at 161 centers in 26 countries worldwide: Australia, Bulgaria, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Israel, Italy, South Korea, Latvia, Lithuania, The Netherlands, Poland, Portugal, Russia, Slovakia, Spain, UK and USA.
Pre-assignment details
853 patients were randomized in a 1:1 ratio to receive secukinumab 300 mg (N=426) or adalimumab 40 mg (N=427); All randomized patients were analyzed for efficacy and safety.
Participants by arm
| Arm | Count |
|---|---|
| Secukinumab 300 mg s.c. Secukinumab 300 mg administered at Baseline, Weeks 1, 2, 3 and 4, followed by dosing every 4 weeks until Week 48. | 426 |
| Adalimumab 40 mg s.c. Adalimumab 40 mg administered at Baseline followed by dosing every 2 weeks until Week 50. | 427 |
| Total | 853 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 13 | 21 |
| Overall Study | Lack of Efficacy | 11 | 23 |
| Overall Study | Lost to Follow-up | 3 | 3 |
| Overall Study | Physician Decision | 3 | 0 |
| Overall Study | Protocol Violation | 3 | 1 |
| Overall Study | Withdrawal by Subject | 22 | 41 |
Baseline characteristics
| Characteristic | Secukinumab 300 mg s.c. | Adalimumab 40 mg s.c. | Total |
|---|---|---|---|
| Age, Continuous | 48.5 Years STANDARD_DEVIATION 12.38 | 49.5 Years STANDARD_DEVIATION 12.44 | 49.0 Years STANDARD_DEVIATION 12.41 |
| Race/Ethnicity, Customized American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race/Ethnicity, Customized Asian | 16 Participants | 20 Participants | 36 Participants |
| Race/Ethnicity, Customized Black or African American | 3 Participants | 2 Participants | 5 Participants |
| Race/Ethnicity, Customized Other | 4 Participants | 8 Participants | 12 Participants |
| Race/Ethnicity, Customized Unknown | 1 Participants | 5 Participants | 6 Participants |
| Race/Ethnicity, Customized White | 402 Participants | 391 Participants | 793 Participants |
| Sex: Female, Male Female | 218 Participants | 198 Participants | 416 Participants |
| Sex: Female, Male Male | 208 Participants | 229 Participants | 437 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 1 / 426 | 0 / 427 | 1 / 853 |
| other Total, other adverse events | 226 / 426 | 236 / 427 | 462 / 853 |
| serious Total, serious adverse events | 37 / 426 | 36 / 427 | 73 / 853 |
Outcome results
Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52
Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The primary endpoint is the proportion of patients with monotherapy ACR20 response at Week 52 where monotherapy ACR20 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 20 (ACR20) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 50 (the last dosing visit) 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)
Time frame: Week 52
Population: Full Analysis Set (FAS)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Secukinumab 300 mg s.c. | Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52 | 67.4 Percentage of Participants |
| Adalimumab 40 mg s.c. | Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52 | 61.5 Percentage of Participants |
Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52
The HAQ-DI assesses a subject's level of functional ability and includes questions of fine movements of the upper extremity, locomotor activities of the lower extremity, and activities that involve both upper and lower extremities. There are 20 questions in 8 categories of functioning including dressing, rising, eating, walking, hygiene, reach, grip and usual activities. The stem of each item asks 'Over the past week, are you able to... perform a particular task'. Each item is scored on a 4 point scale from 0 - 3, representing normal, no difficulty (0), some difficulty (1), much difficulty (2) and unable to do (3). The disability index score is calculated as the mean of the available category scores, ranging from 0 to 3. A negative change from baseline indicates improvement.
Time frame: Baseline, Week 52
Population: Full Analysis Set (FAS)
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Secukinumab 300 mg s.c. | Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52 | -0.58 Unit on a scale | Standard Error 0.027 |
| Adalimumab 40 mg s.c. | Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52 | -0.56 Unit on a scale | Standard Error 0.027 |
Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52
Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The secondary endpoint is the proportion of patients with monotherapy ACR50 response at Week 52 where monotherapy ACR50 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 50 (ACR50) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 52 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)
Time frame: Week 52
Population: Full Analysis Set (FAS)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Secukinumab 300 mg s.c. | Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52 | 49.0 Percentage of Participants |
| Adalimumab 40 mg s.c. | Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52 | 44.8 Percentage of Participants |
Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52
The PASI is a system used for assessing and grading the severity of psoriatic lesions. In the PASI system, the body is divided into 4 regions: the head, trunk, upper extremities, and lower extremities. Each of these areas were assessed separately for the percentage of the area involved, which translates to a numeric score that ranges from 0 to 6, and for erythema, induration, and scaling, which are each rated on a scale of 0 to 4. The PASI produces a numeric score that can range from 0 to 72. A higher score indicates more severe disease. A PASI 90 response represents participants who achieved at least a 90 percent improvement from baseline in the PASI score.
Time frame: Week 52
Population: Psoriasis Subset of the Full Analysis Set (FAS)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Secukinumab 300 mg s.c. | Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52 | 65.4 Percentage of Participants |
| Adalimumab 40 mg s.c. | Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52 | 43.2 Percentage of Participants |
Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52
Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Resolution was defined as the absence of recorded enthesitis; conducted by the study assessor.
Time frame: Week 52
Population: Enthesitis Subset (LEI) of the Full Analysis Set (FAS)
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Secukinumab 300 mg s.c. | Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52 | 60.5 Percentage of Participants |
| Adalimumab 40 mg s.c. | Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52 | 54.2 Percentage of Participants |