Abstract
BackgroundPain is one of the most important domains affecting health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA). Secukinumab has demonstrated rapid and sustained improvements in signs and symptoms, including HRQoL, among patients with active PsA. This analysis evaluates the effect of secukinumab on patient-reported pain in PsA through 104 weeks of treatment.MethodsPain was assessed through week 104 using clinically relevant measures, including change from baseline in a pain visual analog scale (VAS) and Short Form-36 (SF-36) bodily domain scores; proportion of patients reporting improvements equal to or better than minimum clinically meaningful differences in the pain VAS and SF-36 bodily pain domain scores; and proportion of patients with no, moderate, or extreme pain/discomfort measured by the EuroQoL 5-Dimension 3-Level Questionnaire (EQ-5D-3 L) pain item scores. Correlations of pain measures were analyzed using Pearson’s correlation coefficient. Pre-specified analyses of TNF-naïve patients and patients who stopped TNF-inhibitors (TNFis) due to inadequate responses or safety/tolerability (TNF-IR patients) were performed using “as-observed data.”ResultsMean improvements from baseline in pain VAS scores were greater with secukinumab versus placebo by week 3 (− 16.9; P < 0.0001 with secukinumab 300 mg and − 12.6; P < 0.05 with secukinumab 150 mg) and sustained through week 104. SF-36 bodily pain domain scores were significantly greater with 300 mg secukinumab and secukinumab 150 mg versus placebo by week 4 (16.2 and 16.3, respectively; P < 0.0001 for both), and these changes were maintained through week 104. With both secukinumab 300 mg and secukinumab 150 mg, improvements equal to or better than the minimum clinically meaningful differences in pain VAS and SF-36 bodily pain were significant versus placebo at week 3 and week 4, respectively. At week 4, 15%, 9%, and 5% of patients receiving secukinumab 300 mg, secukinumab 150 mg, and placebo, respectively, reported “no pain/discomfort” measured by EQ-5D-3 L; these proportions increased to week 104 with both secukinumab doses. Similarly, improvements in pain measures were significant in both TNF-naïve and TNF-IR patients.ConclusionSecukinumab provided rapid and sustained pain relief in PsA over 2 years of treatment. Improvements in pain were reported regardless of prior exposure to TNFis.Trial registrationClinicalTrials.gov, NCT01752634. Registered on 19 December 2012.
Highlights
Pain is one of the most important domains affecting health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA)
At the Outcome Measures in Rheumatology (OMERACT) 2016 conference, pain was endorsed as part of a core set of domains recommended for study in randomized controlled trials (RCTs) and longitudinal observational studies (LOS) in PsA [12]
In the overall patient population, mean pain visual analog scale (VAS) scores were in the range of 55.4–58.9 and mean Short Form-36 (SF-36) bodily pain scores were in the range of 33.7–37.6
Summary
Pain is one of the most important domains affecting health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA). Secukinumab has demonstrated rapid and sustained improvements in signs and symptoms, including HRQoL, among patients with active PsA This analysis evaluates the effect of secukinumab on patient-reported pain in PsA through 104 weeks of treatment. In a European League Against Rheumatism (EULAR) initiative to develop and validate the Psoriatic Arthritis Impact of Disease questionnaire (PsAID), patients with PsA identified pain as the most important health domain affecting HRQoL [7]. Treatment criteria, scoring indices, and clinical trial domains further reflect the importance of pain in PsA. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) includes pain as an important factor to examine when treating patients with PsA [10]. At the Outcome Measures in Rheumatology (OMERACT) 2016 conference, pain was endorsed as part of a core set of domains recommended for study in randomized controlled trials (RCTs) and longitudinal observational studies (LOS) in PsA [12]
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