Background As of January 15, 2016, secukinumab became the first fully human anti–interleukin-17 monoclonal antibody approved for the treatment of patients with psoriatic arthritis (PsA) in the United States. Secukinumab may be administered with or without loading of 150 mg or 300 mg (patients with concomitant moderate to severe psoriasis only) at weeks 0, 1, 2, 3 and 4 followed by maintenance dosing every 4 weeks. The use of a loading regimen of secukinumab in a real-world setting of patients with PsA has not been evaluated since its approval in the United States.
Objectives To better understand the real-world use of secukinumab by describing the demographic, clinical and treatment characteristics (loading vs no loading) of secukinumab-treated patients with PsA.
Methods Retrospective data from the Symphony Health Solutions Lx commercial claims database were used to identify patients who had ≥1 secukinumab claim between 01/15/2016 and 06/30/2016. Patients who were included in the analysis were aged ≥18 years, had ≥1 ICD-9 code of 696.0 or ICD-10 code of L40.5 for PsA and had ≥1 pharmacy or medical claim in the 12 months prior to their first secukinumab claim (index date). Patient demographics and secukinumab dosage were examined at the index date. Clinical characteristics, comorbidities and treatment history in the 12 months prior to the index date were identified and presented by use vs no use of loading.
Results A total of 764 patients met the inclusion criteria. The mean (SD) age was 50.7 (11.6) years, 58.5% of patients were female and 39.8% of patients were from the south. The most common specialties prescribing secukinumab to patients with PsA were rheumatologists (52.1%) and dermatologists (30.0%). A total of 608 patients (79.6%) received loading and 156 (20.4%) did not; at the index date, the majority of patients received secukinumab at the 300-mg dose in the loading (73.2%) and no loading (84.6%) groups. Patient demographics, clinical characteristics and treatment history were generally comparable between groups (Table 1). However, more patients with loading had prior oral corticosteroid (OCS; 30.9% vs 20.5%), targeted synthetic disease-modifying antirheumatic drug (tsDMARD; 24.7% vs 17.3%) and biologic (64.3% vs 59.6%) use compared with those without loading. The most prevalent comorbidities were psoriasis (58.8%), hypertension (34.4%) and hyperlipidemia (26.8%). A higher proportion of patients with loading had hypertension (35.2% vs 31.2%), rheumatoid arthritis (RA; 15.3% vs 10.9%), fatigue (13.5% vs 9.0%) and anxiety (13.3% vs 8.3%) and a lower proportion had psoriasis (57.4% vs 64.1%) compared with those without loading.
Conclusions This US claims-based study found the majority ($≈ $ 73%) of secukinumab-treated patients with PsA were initiated with a loading regimen. Most patients initiated the 300-mg dose regardless of loading. A higher proportion of patients with loading had prior OCS, tsDMARD and biologic use, as well as hypertension, RA, fatigue and anxiety compared with those without loading, suggesting patients who initiated with loading had more refractory disease. These results provide the first insights into real-world use of secukinumab with and without loading in patients with PsA in the United States.
Acknowledgements This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ.
Disclosure of Interest K. Oelke Consultant for: Novartis, Speakers bureau: Amgen, AbbVie, Bristol-Meyers Squibb, Pfizer, G. Chun Employee of: Novartis, Y. Li Employee of: Novartis, X. Liu Consultant for: Novartis, Employee of: KMK Consulting, Inc, J. Palmer Employee of: Novartis