Overall and sex-specific predictors of secukinumab effectiveness in European patients with psoriatic arthritis: results from the EuroSpA collaboration.

Abstract

Identifying patient characteristics that predict treatment response in psoriatic arthritis (PsA) may help optimise treat-to-target strategies. We aimed to explore overall and sex-specific predictors of secukinumab effectiveness in European patients with PsA treated in routine care. We analysed data from 14 registries in the European Spondyloarthritis (EuroSpA) Research Collaboration. Patients ≥18 years at diagnosis, initiating secukinumab treatment from January 2015 to January 2021, were included. Multiple imputation was utilized for missing covariates at treatment start (baseline) and Disease Activity index for PsA using 28 joints (DAPSA28) at 6 months. Overall and sexstratified analyses were performed by logistic and Cox regressions to identify baseline predictors of treatment outcomes: 1) DAPSA28 low disease activity (LDA: DAPSA28 ≤14) at 6 months, 2) DAPSA28 moderate response at 6 months, and 3) secukinumab discontinuation within 12 months. A total of 2,790 patients (43% males) were included. Median age was 43 years (interquartile range: 34-52), and secukinumab was first-line biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) in 665 (24%) patients. Positive predictors for both DAPSA28 LDA and DAPSA28 moderate response were male sex, fewer previous b/tsDMARDs, C-reactive protein (CRP)>10mg/L, and lower Health Assessment Questionnaire score. Absence of psoriasis, higher patient fatigue and tender joint counts predicted secukinumab discontinuation within 12 months. For some outcomes, sex-specific predictors were fewer previous b/tsDMARDs and CRP>10mg/L among males and lower patient fatigue score among females. We identified overall and sex-specific predictors of secukinumab effectiveness in European patients with PsA. Our findings may support personalized treatment decisions.