Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials

Arthur Kavanaugh, Christopher Ritchlin, Proton Rahman, Lluis Puig, Alice B Gottlieb, Shu Li, Yuhua Wang, Lenore Noonan, Carrie Brodmerkel, Michael Song, Alan M Mendelsohn, Iain B McInnes, PSUMMIT-1 and 2 Study Groups, Arthur Kavanaugh, Christopher Ritchlin, Proton Rahman, Lluis Puig, Alice B Gottlieb, Shu Li, Yuhua Wang, Lenore Noonan, Carrie Brodmerkel, Michael Song, Alan M Mendelsohn, Iain B McInnes, PSUMMIT-1 and 2 Study Groups

Abstract

Objective: Evaluate ustekinumab, an anti-interleukin (IL)-12 and IL-23 antibody, effects on radiographic progression in psoriatic arthritis (PsA).

Methods: We conducted preplanned integrated analyses of combined radiographic data from PSUMMIT-1 and PSUMMIT-2 phase 3, randomised, controlled trials. Patients had active PsA despite prior conventional and/or biologic disease-modifying antirheumatic drugs (≥5/66 swollen, ≥5/68 tender joints, C-reactive protein ≥3.0 mg/L, documented plaque psoriasis). Patients (PSUMMIT-1, n=615; PSUMMIT-2, n=312) were randomised to ustekinumab 45 mg, 90 mg, or placebo, at weeks (wk) 0, 4 and every (q) 12 wks. At wk 16, patients with <5% improvement in tender/swollen joint counts entered blinded early escape. All other placebo patients received ustekinumab 45 mg at wk 24 and wk 28, then q 12 wks. Radiographs of hands/feet at wks 0/24/52 were assessed using PsA-modified van der Heijde-Sharp (vdH-S) scores; combined PSUMMIT-1 and PSUMMIT-2 changes in total vdH-S scores from wk 0 to wk 24 comprised the prespecified primary radiographic analysis. Treatment effects were assessed using analysis of variance on van der Waerden normal scores (factors=treatment, baseline methotrexate usage, and study).

Results: Integrated data analysis results indicated that ustekinumab-treated patients (regardless of dose) demonstrated significantly less radiographic progression at wk 24 than did placebo recipients (wk 0-24 total vdH-S score mean changes: 0.4-combined/individual ustekinumab dose groups, 1.0-placebo; all p<0.02). From wk 24 to wk 52, inhibition of radiographic progression was maintained for ustekinumab-treated patients, and progression was substantially reduced among initial placebo recipients who started ustekinumab at wk 16 or wk 24 (wk 24 - wk 52, total vdH-S score mean change: 0.08).

Conclusions: Ustekinumab 45 and 90 mg treatments significantly inhibited radiographic progression of joint damage in patients with active PsA.

Keywords: Anti-TNF; Psoriatic Arthritis; Spondyloarthritis.

Figures

Figure 1
Figure 1
Changes in PsA-modified vdH-S score—mean change from baseline over time through week 52 (A) and cumulative probability plot of change from baseline to week 24 (B). Pbo, placebo; PsA, psoriatic arthritis; SDC, smallest detectable change; UST, ustekinumab; vdH-S, van der Heijde-Sharp.
Figure 2
Figure 2
Changes in PsA-modified vdH-S score from baseline to week 24 for the combined PSUMMIT-1 and 2 ((A)—primary analysis), PSUMMIT-1 (B), and PSUMMIT-2 (C) trials. PsA, psoriatic arthritis; UST, ustekinumab; vdH-S, van der Heijde-Sharp.

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