A recent post hoc analysis published in Rheumatology (Oxford) has shown that patients with psoriatic arthritis (PsA) who did not experience radiographic progression over two years of treatment with secukinumab achieved significantly higher rates of low disease activity and remission compared with those who demonstrated structural progression. The findings further clarify the relationship between sustained inflammation control, inhibition of structural damage, and long-term clinical outcomes in PsA.
Psoriatic arthritis is a chronic, immune-mediated inflammatory disease involving peripheral joints, entheses, skin, and axial structures, with progressive joint damage contributing to disability and impaired quality of life. Structural progression, typically assessed using the van der Heijde modified Total Sharp Score (vdH-mTSS), is a key marker of irreversible joint damage and remains a central therapeutic target. Secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A (IL-17A), targets a pivotal cytokine in PsA pathogenesis that drives synovial inflammation, osteoclast activation, and bone erosion.
The current analysis drew on data from the phase 3 FUTURE 5 trial, which enrolled 541 patients with active PsA who received secukinumab 300 mg with a loading dose, 150 mg with a loading dose, or 150 mg without a loading dose. Radiographic progression was defined as a change from baseline to week 104 in vdH-mTSS greater than 0.5. At two years, 457 patients (84.5%) were classified as radiographic non-progressors, while 84 (15.5%) were progressors. Significantly higher proportions of non-progressors achieved minimal disease activity (MDA), very low disease activity (VLDA), and Disease Activity Index for PsA (DAPSA)–defined low disease activity and remission. Non-progressors also reported better physical function and lower pain scores, reinforcing the clinical importance of preventing structural joint damage.
Radiographic progression was associated with older age and elevated baseline high-sensitivity C-reactive protein levels, consistent with prior evidence linking systemic inflammation and longer disease duration to structural damage accrual. Conversely, non-progression was more frequently observed in patients treated with secukinumab 300 mg compared with 150 mg without a loading dose, in those without prior tumor necrosis factor inhibitor (TNFi) exposure, and in patients with lower baseline body mass index. These associations suggest that both early intervention and optimal dosing may enhance structural protection.
These findings align with earlier results from the broader FUTURE clinical trial program, including FUTURE 1 and FUTURE 2, which demonstrated that secukinumab significantly improved the signs and symptoms of PsA compared with placebo and inhibited radiographic progression through one year of therapy. Long-term extension studies have shown sustained clinical efficacy and inhibition of structural damage for up to five years. Importantly, benefits were observed regardless of prior TNFi exposure, although biologic-naïve patients tended to achieve higher response rates. Previous analyses have also shown that secukinumab improves enthesitis, dactylitis, and patient-reported outcomes, further supporting its multidomain efficacy.
The accumulating evidence indicates that IL-17A inhibition with secukinumab not only provides robust symptomatic relief but also meaningfully reduces structural joint damage over time. The current analysis strengthens the treat-to-target paradigm in PsA, emphasizing that achieving radiographic non-progression is closely linked to higher rates of sustained remission and improved functional outcomes, particularly when therapy is initiated early and administered at appropriate doses.
References
- Mease PJ, Coates LC, Gaillez C, Shew A, Bao W, Ritchlin CT. Relationship of radiographic progression status to low disease activity in patients with PsA receiving secukinumab treatment for 2 years. Rheumatology (Oxford). 2026 Jan 8;65(1):keaf488.
- Blair HA. Secukinumab: A Review in Psoriatic Arthritis. Drugs. 2021 Mar;81(4):483-494. doi: 10.1007/s40265-021-01476-3. Epub 2021 Mar 4. Erratum in: Drugs. 2021 Apr;81(6):735.