Secukinumab may reverse and prevent joint damage in psoriatic arthritis

Secukinumab may facilitate partial erosion repair and prevent enthesiophyte progression in patients with psoriatic arthritis (PsA), according to a phase IV randomized clinical trial (RCT).

“The limitations in movement and physical functions from joint damage can significantly affect PsA patients’ quality of life, impacting their ability to perform daily tasks and participate in social activities,” said Professor Lai-Shan Tam, Head of the Division of Rheumatology, Chinese University of Hong Kong (CUHK).

Although various treatments are available for PsA, joint damage resulting from PsA is often regarded as irreversible. “There is a lack of clinical evidence on the long-term effect of treatment in preventing joint erosion,” Tam highlighted. [Arthritis Rheumatol 2025;doi:10.1002/art.43154]

IL-17: Key to bone remodelling in PsA

Interleukin (IL)-17 is a key cytokine involved in pathogenesis of PsA and plays an important role in the development of bone erosion. “This is the first RCT to evaluate the effects of secukinumab [an anti–IL-17 biologic] in preventing bone damage in PsA using high-resolution peripheral quantitative CT,” noted the researchers.

Forty patients with active PsA (mean age, 51.9 years; male, 50 percent; mean disease duration, 4.7 years) were recruited and randomized 1:1 to receive subcutaneous secukinumab or placebo. Patients were allowed to receive single or combination conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) if they did not reach treatment targets.

The median erosion volume in the placebo group was 1.2 mm³ at baseline, 1.1 mm³ at week 24, and 1.3 mm³ at week 48. In the secukinumab group, median erosion volume remained unchanged, at 0.9 mm³, across these time points.

At week 48, more patients in the secukinumab vs placebo group achieved minimal disease activity (55.6 vs 31.3 percent).

One year makes a difference with secukinumab

After 1 year, secukinumab significantly reduced the volume of pre-existing erosion (median change, -0.1 vs 0.0 mm³; p=0.004) vs placebo.

3D bone model: Partial healing of bone erosion after 1 year of secukinumab treatment

More importantly, secukinumab was more effective in achieving partial erosion healing (odds ratio [OR], 2.88; 95 percent confidence interval [CI], 1.13–7.35; p=0.027) and preventing enthesophyte progression (OR, 0.26; 95 percent CI, 0.08–0.09; p=0.030) vs placebo, highlighting the possibility of pathway-specific bone remodelling in PsA.

“IL-17 inhibition provided additional benefits by helping to repair joint damage and preventing further bone changes, suggesting it could be a valuable treatment option for PsA,” commented first author Dr Issac Tsz-Ho Cheng, a postdoctoral fellow of the Department of Medicine & Therapeutics at CUHK.

“Very often, PsA patients are unaware of the need to monitor for joint damage if they believe their inflammation and pain are well controlled. [However,] the difference in volume of pre-existing erosions between the two groups [in the study] became significant over just 1 year,” pointed out Tam. “It is important for patients with PsA to monitor their joint damage progression and take preventive therapeutic measures if necessary.”