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  • Effects of ustekinumab on spondylitis-associated endpoints in TNFi-naïve active psoriatic arthritis patients with physician-reported spondylitis: pooled results from two phase 3, randomised, controlled trials

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Psoriatic arthritis
Original research
Effects of ustekinumab on spondylitis-associated endpoints in TNFi-naïve active psoriatic arthritis patients with physician-reported spondylitis: pooled results from two phase 3, randomised, controlled trials
  1. Philip S Helliwell1,
  2. Dafna D Gladman2,
  3. Soumya D Chakravarty3,4,
  4. Shelly Kafka3,
  5. Chetan S Karyekar5,
  6. Yin You6,
  7. Kim Campbell6,
  8. Kristen Sweet6,
  9. Arthur Kavanaugh7 and
  10. Lianne S Gensler8
  1. 1Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
  2. 2Krembil Institute, University of Toronto, Toronto, Ontario, Canada
  3. 3Janssen Scientific Affairs LLC, Horsham, Pennsylvania, USA
  4. 4Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
  5. 5Janssen Global Services LLC, Horsham, Pennsylvania, USA
  6. 6Janssen Research & Development LLC, Spring House, Pennsylvania, USA
  7. 7University of California San Diego, La Jolla, California, USA
  8. 8University of California San Francisco School of Medicine, San Francisco, California, USA
  1. Correspondence to Philip S Helliwell; p.helliwell{at}leeds.ac.uk

Abstract

Background The interleukin-12/23p40-subunit-inhibitor ustekinumab significantly improved spondylitis-related symptoms through Week 24 in psoriatic arthritis (PsA) patients with peripheral arthritis and physician-reported spondylitis (PA-PRS) in PSUMMIT-1&2. We further evaluated ustekinumab’s effect on spondylitis-related endpoints in PSUMMIT-1&2 tumour necrosis factor-inhibitor (TNFi)-naïve patients with PA-PRS.

Methods Patients with active PsA (≥5 swollen and ≥5 tender joints, C-reactive-protein ≥ 3.0 mg/L) despite conventional (PSUMMIT-1&2) and/or prior TNFi (PSUMMIT-2) therapy received subcutaneous ustekinumab 45 mg, 90 mg or placebo (Week 0, Week 4, Week 16). Changes in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) neck/back/hip pain question (#2) and modified BASDAI (mBASDAI, excluding PA) scores and Ankylosing Spondylitis Disease Activity Score (ASDAS) responses were assessed at Weeks 12 and 24.

Results The pooled PSUMMIT-1&2, TNFi-naïve (n=747), PA-PRS (n=223) subset (158 with human-leucocyte-antigen (HLA)-B27 results) presented with moderate-to-severe spondylitis-related symptoms (mean BASDAI-neck/back/hip pain-6.51, mBASDAI-6.54, BASDAI-6.51, ASDAS-3.81). Mean Week 24 changes were larger among ustekinumab than placebo-treated patients for both neck/back/hip pain (−1.99 vs −0.18) and mBASDAI (−2.09 vs −0.59). Improvements in neck/back/hip pain and fatigue appeared numerically greater in HLA-B27+ than HLA-B27– patients; those for other domains were generally consistent. Greater proportions of ustekinumab versus placebo-treated patients achieved ASDAS clinically important improvement at Week 24 (decrease ≥ 1.1; 49.6% vs 12.7%; nominal p<0.05).

Conclusions Improvements in BASDAI neck/back/hip pain and mBASDAI among ustekinumab-treated, TNFi-naïve, PsA patients with PA-PRS were clinically meaningful and consistent across assessment tools. Numerically greater improvements in neck/back/hip pain in HLA-B27+ than HLA-B27– patients, noted in the context of similar overall mBASDAI improvements between the subgroups, suggest ustekinumab may improve disease activity in TNFi-naïve PsA patients likely to exhibit axial disease.

Clinical trial registration numbers PSUMMIT 1, NCT01009086; PSUMMIT 2, NCT01077362.

  • psoriatic arthritis
  • axial disease
  • interleukin-12/23
  • ustekinumab
  • HLA-B27
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rmdopen-2019-001149

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    Footnotes

    • Contributors All authors contributed to the study design, YY conducted the data analysis, and all authors interpreted the data and revised the manuscript.

    • Funding This study was funded by Janssen Research & Development, LLC.

    • Competing interests PH has received research grants and/or payments to third parties for lectures and educational material development/events (<$10 000) from AbbVie, Amgen, Celgene, Janssen, Novartis, Pfizer and UCB. DDG has received grants and/or consultancies (<$10 000) from AbbVie, Amgen, BMS, Celgene, Eli Lilly, Gilead, Janssen, Novartis, Pfizer and UCB. SDC, SK and CSK are employees of Janssen Scientific Affairs/Global Services and own stock in Johnson & Johnson, of which Janssen Scientific Affairs & Global Services are wholly owned subsidiaries. YY, KC and KS are employees of Janssen Research & Development, LLC and own stock in Johnson & Johnson, of which Janssen Research & Development, LLC, is a wholly owned subsidiary. AK has received consulting fees and research support from AbbVie, Amgen, Janssen, Lilly, Novartis, Pfizer and UCB. LSG has received consulting honoraria from Eli Lilly, GlaxoSmithKline, and Novartis and research grant support from AbbVie, Amgen, Pfizer, and UCB.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are available upon reasonable request.