Male sex, elevated C-reactive protein (CRP), lower number of previous biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARD) used, and lower Health Assessment Questionnaire (HAQ) score are all predictive of treatment response in European patients with psoriatic arthritis (PsA) treated with secukinumab, a study has shown.
Furthermore, the predictors of treatment discontinuation within a year include absence of psoriasis, higher patient fatigue score, and higher tender joint count of 28 joints (TJC28).
“When stratified by sex, certain variables remained predictors independently of sex, whereas others did not,” said the author, led by Dr Jette Heberg, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.
Heberg and colleagues analysed data from 14 registries in the European Spondyloarthritis Research Collaboration. A total of 2,790 patients with PsA (median age 43 years, 43 percent male) who initiated secukinumab treatment from January 2015 to January 2021 were included. Multiple imputation for missing covariates at baseline and Disease Activity Index for Psoriatic Arthritis based on 28 joints (DAPSA28) at 6 months were used.
Logistic and Cox regressions were also used to conduct overall and sex-stratified analyses, which identified baseline predictors of these outcomes: DAPSA28 low disease activity (LDA; DAPSA28 ≤14) at 6 months, DAPSA28 moderate response at 6 months, and secukinumab discontinuation within 12 months.
Of the patients, 665 (24 percent) used secukinumab as first-line b/tsDMARD. Both DAPSA28 moderate response and DAPSA28 LDA were predicted by male sex, fewer previous b/tsDMARDs, CRP >10 mg/L, and lower HAQ score. [J Rheumatol 2026;53:977-985]
On the other hand, absence of psoriasis, higher patient fatigue, and TJC28 were significantly associated with secukinumab discontinuation within 12 months. For some outcomes, fewer previous b/tsDMARDs and CRP >10 mg/L were predictive of treatment effectiveness among male patients and lower patient fatigue score among female patients.
Sex-specific differences
“The growing evidence of divergent treatment effects, along with the known differences in disease manifestations and disease course between the sexes, could suggest the presence of underlying sex-specific biologic differences in the disease mechanisms,” wrote Heberg and colleagues. [Nat Rev Rheumatol 2022;18:513-526]
“These potentially inherent sex-dependent differences in PsA underscore the relevance of exploring predictors of treatment response separately for male and female individuals. Notably, this requires a large sample size, as in the present study,” they added.
While the authors found mostly consistent predictors between sexes, they also noted fewer previous b/tsDMARDs as predictive of all three outcomes in male individuals, but not in female patients.
“Since the study by Molica Colella and colleagues included mainly women, our finding of a link between male sex and the predictive role of previous b/tsDMARDs might offer a potential explanation for the contradictory finding that previous tumour necrosis factor inhibitor treatment was not predictive of treatment response to secukinumab in their analysis,” the authors said. [Adv Rheumatol 2023;63:1-12]
PsA, an inflammatory joint disease, is characterized by different signs and symptoms, including peripheral arthritis, axial spondyloarthritis, enthesitis, dactylitis, and psoriasis. [N Engl J Med 2017;376:2097]
“Although the male-to-female PsA ratio is roughly 1:1, the disease manifestations, course, and treatment response differ between male and female individuals,” wrote Heberg and colleagues.