ACR 2017 | Daily Highlights
Efficacy and Safety of Ixekizumab in Patients with Active Psoriatic Arthritis and Previous Inadequate Response to TNF Inhibitors: 52-Week Results from a Phase 3 Study
Authors: Mark C. Genovese1, Bernard Combe2, Joel Kremer3, David Adams4, Chin Lee4, Lisa Kerr4 and Peter Nash5, 1Stanford University Medical Center, Palo Alto, CA, 2Rheumatology, CHU Lapeyronie and Montpellier University, Montpellier, France, 3St. Peter's Hospital, Albany, NY, 4Eli Lilly and Company, Indianapolis, IN, 5University of Queensland, Brisbane, Australia
Ixekizumab (IXE) is a high affinity monoclonal antibody that selectively targets interleukin-17A. In patients with active psoriatic arthritis (PsA) who had an inadequate response to tumor necrosis factor inhibitors (TNFi), IXE was superior to placebo (PBO) in improving the signs and symptoms of PsA after 24 weeks of treatment (SPIRIT-P2; NCT02349295).1 The objective of this study is to report the Week 52 interim efficacy and safety findings of IXE treatment during the Extension Period (EP) of SPIRIT-P2 (Weeks 24-156).
SPIRIT-P2 is a phase 3, multicenter, double-blind study. All 363 patients had an inadequate response to one or two TNFi or were intolerant to TNFi. During the Double-Blind Treatment Period (DBTP; Weeks 0-24), patients were randomly assigned 1:1:1 to subcutaneous administration of either 80 mg IXE every 4 weeks (Q4W; N=122) or every 2 weeks (Q2W; N=123) following a 160 mg starting dose at Week 0, or PBO (N=118). Of these, 310 patients completed the DBTP and entered the EP (Weeks 24-156). Patients randomized to IXE at Week 0 continued the same dose regimen in the EP. PBO patients were re-randomized (1:1) to IXE Q4W or Q2W at Week 16 (inadequate responders) or 24. In this interim analysis, efficacy (up to Week 52) and safety (up to Week 156) were analyzed using the EP population, defined as all patients who received at least 1 dose of study drug in the EP. Missing values were considered non-response for categorical data and were imputed by modified baseline observation carried forward for continuous data.
In the DBTP, a significantly higher percentage of patients achieved ACR20 at Week 24 with IXE Q4W (53%) or Q2W (48%) than with PBO (20%).1 For patients who entered the EP, the mean age was 52 years, 47% were male, the mean time since PsA onset was 12 years, and mean tender and swollen joint counts at baseline (Week 0) were 23 and 12, respectively. For EP patients who were initially randomized to IXE Q4W or Q2W during the DBTP, ACR20 responses at Week 52 were 68% and 59%, respectively. For patients treated with PBO during the DBTP and re-randomized to IXE Q4W or Q2W during the EP, ACR20 responses at Week 52 were 61% and 50%, respectively. Additional efficacy measures are depicted in the Table. The frequency of adverse events (AEs) in the EP are presented in the Table; the majority were mild or moderate in severity. Serious AEs occurred in 15 patients, and one death occurred in the EP population: a myocardial infarction in a PBO/IXE Q2W patient 502 days after starting IXE.
IXE demonstrated sustained improvement in the signs and symptoms of PsA across treatment groups during the EP. The safety profile of IXE observed in the EP population was consistent with the safety profile of the intent-to-treat population in the DBTP of SPIRIT-P2.1
Nash P et al. Lancet. 2017. E-pub ahead of print 24 May, 2017. http://dx.doi.org/10.1016/S0140-6736(17)31429-0
M. C. Genovese, Eli Lilly and Company, Abbvie, Astellas, Galapagos, Pfizer, Vertex, Crescendo Bioscience, 5; B. Combe, Pfizer, UCB, 2,BMS, Janssen, Lilly, MSD,Pfizer, Roche-Chugai, UCB, 8,Abbvie, BMS,Janssen, Lilly, MSD,Novartis, Pfizer, Roche-Chugai, UCB, 5; J. Kremer, Abbvie, Amgen, BMS, Genentech, GSK, Eli Lilly and Company, Novartis, Pfizer, 5,Abbvie, Genentech, Eli Lilly and Company, Novartis, Pfizer, 2,Genentech, Biogen IDEC Inc, 8,Corrona, 1,Corrona, 3; D. Adams, Eli Lilly and Company, 1,Eli Lilly and Company, 3; C. Lee, Eli Lilly and Company, 1,Eli Lilly and Company, 3; L. Kerr, Eli Lilly and Company, 1,Eli Lilly and Company, 3; P. Nash, AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Hospira, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, 5,AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Hospira, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, 8,AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Hospira, Janssen, MSD, Novartis, Pfizer, Roche, Sanofi, and UCB, 2.
We have been used for years different TNF inhibitors, which had broadened the therapeutic armamentarium in several inflammatory rheumatic diseases and allowed patients to select their most convenient injection interval. Ixekizumab (Taltz) is a second inhibitor of interleukin 17A and is already licensed for use in Switzerland in patients with psoriasis. The current study in active psoriatic arthritis patients with an inadequate response to TNF inhibitors demonstrates an ACR20 response rate of 50% at 6 months of treatment. This is only slightly lower than in patients with inadequate response to conventional DMARDs (ca. 60%).
PD Dr. Adrian Ciurea