Baseline radiographic damage prevalence ‘substantial’ in psoriatic arthritis
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Patients with psoriatic arthritis demonstrate a “substantial prevalence” of radiographic damage at baseline, which is related to time since diagnosis, according to data published in Arthritis Research and Therapy.
The data come from an analysis of two phase 3 trials — FUTURE 1 and FUTURE 5 — of secukinumab (Cosentyx, Novartis) in PsA. The researchers additionally concluded that patients’ individual joint activity was strongly associated with pre-existing radiographic damage, and that those with the highest baseline damage were less likely to achieve zero joint count status.
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“The ability to do this post-hoc analysis of radiographic and clinical data comes from FUTURE 1 and 5, both of which were studies of PsA patients treated with secukinumab with radiographic assessment and aimed to assess prevalence and magnitude of radiographically-evident joint damage, as well as joint tenderness and swelling, at baseline and post-treatment at an individual patient and individual joint level,” Philip Mease, MD, of the Swedish Medical Center, in Seattle, told Healio. “What was unique was the ability to do this analysis at the individual joint level.”
To examine the prevalence of pre-existing radiographic damage at baseline in patients with PsA, as well as the correlation between radiographic damage and baseline tender or swollen joint counts, and its impact on response to secukinumab, Mease and colleagues pooled data from1,554 participants enrolled in the FUTURE 1 and FUTURE 5 trials. The researchers assessed baseline radiographic bone erosion and joint space narrowing scores at pre-specified locations using the van der Heijde-modified total Sharp score (vdH-mTSS) for PsA, as well as swollen and tender joint scores in the same joints at multiple visits.
Additionally, the researchers analyzed the association between joint activity — tenderness and swelling — and vdH-mTSS at the overall patient-level, as well as individual joint tender/swollen scores (yes/no), and joint base narrowing and bone erosion scores, at the individual joint-level. Mease and colleagues assessed treatment response using swollen/tender joint counts at weeks 16 and 52. Meanwhile, the proportion of patients achieving minimal disease activity over all assessments within 1 year was examined using data from FUTURE 5 alone.
Patients in the studies demonstrated a “substantial prevalence” of pre-existing radiographic damage, with a higher prevalence of erosion than joint space narrowing, at 86% vs. 60%, the researchers wrote. Higher prevalence of radiographic damage was associated with longer time since PsA diagnosis.
Meanwhile, joint activity was weakly associated with radiographic damage at baseline at the patient-level, with a Pearson’s coefficients range of 0.12-0.18. However, such activity was strongly associated with damage at the individual joint-level, with a higher probability of tender/swollen joints associated with higher joint space narrowing/erosion scores.
Results were statistically significant at the 0.05 level (unadjusted) for all 42 analyzed joints regarding the link between joint tenderness (yes/no) and its joint space narrowing score; as well as for all but one joint regarding tenderness and bone erosion scores; and for all but two joints regarding swollen and joint space narrowing scores and regarding swollen and bone erosion scores.
Lastly, the researchers found that secukinumab 150/300 mg lowered tender and swollen joint counts across all values of baseline erosion and joint space narrowing scores at 16 and 52 weeks. However, patients with worse radiographic damage were less likely to achieve zero tender/zero swollen joint status or minimal disease activity.
“Given the correlation between disease duration and more joint damage at baseline, and less satisfactory treatment outcomes in those with higher amount of joint damage at baseline, it behooves us to both recognize the disease early and educate our non-rheumatologist colleagues about recognition and triage to rheumatology, so that we can identify and treat patients with joint damage sooner with medications that can inhibit structural damage progression, allowing us greater chance to achieve targets such as minimal disease activity and inhibition of joint damage progression,” Mease said.
He added: “It is helpful to see more granular post-hoc analyses of clinical trial data, including and more sophisticated computational analysis and artificial intelligence methodologies to provide deeper insights from clinical trial data sets.”
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