Carpe Diem Haiku No. 861 Sacred Stones

Three times around

Searched by security men

Then the engine's roar

All the Sacred Stones

Don't hide their secrets from you

Power lies in you

From every journey

You take some stones back to home

Just for memories

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-861-sacred-stones-ovoo.html

Tregalizumab at the ACR 2015 Meeting in San Francisco

There has been one publication on tregalizumab at the ACR 2015 Annual Meeting in San Francisco. “Tregalizumab (BT-061) is a humanized, anti-CD4 mAb, inducing selective Treg activation in vitro.” It seems an interesting concept, as the authors of the study point out: “Previous trials suggested efficacy in RA at doses ≥25 mg subcutaneously (SC).” But let’s come to the dismal truths of the study.

Ronald F. van Vollenhoven and colleagues presented: “A Phase 2b Study Evaluating the Efficacy and Safety of Subcutaneously Administered Tregalizumab in Subjects with Active Rheumatoid Arthritis (RA) Despite Treatment with Methotrexate (MTX)”. But they had to conclude: “No tested doses of tregalizumab demonstrated significant efficacy improving signs and symptoms of active RA based on ACR20 responses at wk 12 and 24 despite dose dependent down-modulation of CD4 expression. Tregalizumab was generally well tolerated.”

Does this mean, that tregalizumab should be abandoned? I guess not. Maybe Tregs act differently in vivo. And I guess, the team around Ronald F. van Vollenhoven will come out with a new idea, on how to make the concept work. Maybe it only works in a form of combination. Looking forward to new developments with tregalizumab.

References:

van Vollenhoven RF, Keystone EC, Strand V, Pacheco-Tena C, Vencovsky J, Behrens F, Zipp D, Rharbaoui F, Wolter R, Tiemann RD, Knierim L, Schmeidl R, Zhou X, Aigner S, Daelken B, Wartenberg-Demand A. A Phase 2b Study Evaluating the Efficacy and Safety of Subcutaneously Administered Tregalizumab in Subjects with Active Rheumatoid Arthritis (RA) Despite Treatment with Methotrexate (MTX) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/a-phase-2b-study-evaluating-the-efficacy-and-safety-of-subcutaneously-administered-tregalizumab-in-subjects-with-active-rheumatoid-arthritis-ra-despite-treatment-with-methotrexate-mtx/. Accessed November 19, 2015.

Iguratimod at the ACR 2015 Meeting in San Francisco

There has been one publication on iguratimod at the ACR 2015 Annual Meeting in San Francisco. Iguratimod is a novel disease modifying anti-rheumatic drug (DMARD); chemical formula: N-(3-Formamido-4-oxo-6-phenoxy-4H-chromen-7-yl)-methanesulfonamide. Iguratimod is characterized by inhibitory effects on immunoglobulin production in B cells as well as inhibiting cytokine production. Its' mode of action comes by suppression of nuclear factor kappa B (NF-kB) activation. As I have already written on Iguratimod before, please look for the links below. 2012 there had been three studies, 2013 one study at the EULAR Meeting in Madrid (a study by a Chinese group), only one study at the ACR 2013 Meeting, but three studies at the EULAR 2014 meeting in Paris, also three studies at the ACR 2014 Meeting and the 2015 EULAR Meeting in Rome. But let’s look at the study now.

Tsuneo Kondo and colleagues presented: “Clinical and Radiographic Outcome of Iguratimod for Rheumatoid Arthritis”. Results: “[…] DAS28-ESR and SDAI decreased significantly from 4.49±1.33 to 3.12±1.08 and from 18.5±10.9 to 8.3±6.34 in 52 weeks respectively (P < 0.01). Remission and LDA rate in DAS28-ESR were 29.0% and 24.2%. HAQ-DI score also decreased from 1.2±0.8 to 0.85±0.79. The percentage of patients with no radiographic progression (ΔmTSS < 0.5) was 56.8%, while that of rapid radiographic progression (ΔTSS > 5) was 13.5%. The mean estimated yearly progression was 9.9 ± 15.6 at baseline. After 52 weeks of IGU treatment, the mean change was significantly reduced to 1.2 ± 2.5(P < 0.01). […]”. So, the author’s concluded: „IGU reduced disease activity and radiographic progression with RA patients. IGU is generally safe and tolerable and may have a good cost effectiveness. So iguratimod be a new useful option as small molecule DMARDs.

Iguratimod has shown to be a promising candidate for treatment of active rheumatoid arthritis and might become a needed alternative in the conventional (traditional) DMARD class. Iguratimod is approved in Japan and hopefully it will be approved in the rest of the world soon. We now have data on radiographic progression, so the drug is one step nearer to approval. But iguratimod is making progress in to little and too few steps. The sponsor of studies should more committed.

References:

Kondo T, Shibata A, Sakai R, Kikuchi J, Chino K, Okuyama A, Takei H, Amano K. Clinical and Radiographic Outcome of Iguratimod for Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/clinical-and-radiographic-outcome-of-iguratimod-for-rheumatoid-arthritis/. Accessed November 18, 2015.

Links:

Iguratimod at the EULAR Meeting 2012

http://rheumatologe.blogspot.de/2012/06/iguratimod-at-eular-2012.html

Iguratimod at the EULAR Meeting 2013

http://rheumatologe.blogspot.de/2013/06/iguratimod-at-eular-2013.html

Iguratimod at the ACR 2013 Meeting

http://rheumatologe.blogspot.de/2014/01/iguratimod-at-acr-2013-meeting-in-san.html

Iguratimod at the EULAR 2014 Meeting

http://rheumatologe.blogspot.de/2014/06/iguratimod-at-eular-2014-meeting-in.html

Capilla San Rafael

While travelling in the Northwest of Argentina, I had to go across the Piedra del Molino, a pass at an altitude of 3457 m, which isn’t much. It belongs to the Valles Calchaquíes. In the barren landscape I’ve found the Capilla San Rafael, where people pray for a safe journey onwards and thank that they’ve reached the pass.

A view of the Capilla

Interior of the Capilla

The surrounding landscape

On my way to work, at the autobahn A57, I pass the German version of a Capilla San Rafael, which belongs to a network of chapels at or near the autobahn – for the same reasons as in South America.

Kapelle St. Raphael in Nievenheim

Interior of the Kapelle

Links:

http://rheumatologe.blogspot.de/2015/11/some-haiku-from-south-america.html

http://rheumatologe.blogspot.de/2015/11/aconcagua.html

Carpe Diem Haiku Special No. 182 Ese's third "in the darkest hour "

In the darkest hour

The stars don’t cease to twinkle

And morning isn’t far

Lonely darkness

Tries to cover all candles

Hope lies in a match

http://chevrefeuillescarpediem.blogspot.de/2015/11/carpe-diem-special-182-eses-third-in.html

Sarilumab at the ACR 2015 Meeting in San Francisco

There have been a couple of publications on sarilumab at the ACR 2015 Annual Meeting in San Francisco. I guess that the proliferation of studies hints at Sanofi thinks to bring sarilumab to the market. I think, it’s still too soon to apply for FDA approval. But let’s look at some of the studies; I’ll quote all studies under references with a link to the ACR Meeting Abstracts.

Vibeke Strand and colleagues presented: “Impact of Sarilumab on Fatigue, Pain, Morning Stiffness, Productivity, and Health Related Quality of Life (HRQoL) in Patients with Active Rheumatoid Arthritis Who Were Inadequate Responders or Intolerant of Anti-TNF-α Therapy: Results from a Phase 3 Study (RCT)” This Phase 3 RCT [randomized controlled trial] showed statistically significant and clinically meaningful changes from baseline in fatigue, morning stiffness, pain, productivity and participation, rheumatoid arthritis impact scores and health related quality of life at Week 24.

There were several studies that looked at different dosages and combinations like the one presented by Roy Fleischmann et al. (Abstract No. 970 / Sarilumab in combination with CsDMARDs in patients with active RA and inadequate responders or intolerant of Anti–TNF-alpha Therapy), Arthur Kavanaugh et al. ( ABSTRACT No. 2760 / Efficacy and safety of sarilumab plus MTX in patients with RA), Mark C. Genovese et al. (ABSTRACT No. 2770 / Efficacy of sarilumab plus methotrexate in achieving clinical Remission in patients with active, moderate-to-severe RA), Maxime Dougados et al. (ABSTRACT No. 2761 / IL-6R blockade with sarilumab plus methotrexate results in changes in clinical and laboratory parameters associated with chronic inflammation), or another evalution by Vibeke Strand et al. (ABSTRACT No. 2313 / Responder rates and numbers needed to treat).

Paul Emery and colleagues presented: “Safety and Tolerability of Subcutaneous Sarilumab Compared to Intravenous Tocilizumab in Patients with RA”. Conclusion: “Overall, there was no clinically meaningful difference between the treatment groups with regards to clinical adverse events. Laboratory changes noted in the sarilumab groups were within the same range as those noted in the tocilizumab groups. […]”.

Gerd Burmester and colleagues looked at: “Sarilumab Dose Reduction to Manage Laboratory Abnormalities in an Open-Label Extension Study in RA Patients”. Conclusions: “In this study, reducing the dose from 200 mg q2w to 150 mg q2w to manage laboratory abnormalities allowed the majority of patients to continue in the study for a mean duration of >1.5 years. For patients continuing in the study, these laboratory abnormalities improved during the 6 months following dose reduction, and efficacy was maintained.” Two points: 1. necessity to reduce dose at all makes me uneasy, 2. if efficacy is maintained, why use a higher dosage at all? There might be at least a subgroup of patients, in whom a lower dosage could be possible.

Now, we come to Anita Boyapati and colleagues, who presented: “Evaluation of Bone and Joint Proteins for Prognostic Association with Radiographic Progression and Disease Activity in Methotrexate Inadequate Responder Rheumatoid Arthritis Patients in a Sarilumab Phase 3 Study”. Methods: “Serum markers [RANKL, MMP-3 and MMP-cleaved fragments of collagen types 1 and 3 (C1M and C3M)] were measured at baseline and posttreatment in patients receiving Pbo +MTX (n=128) or subcutaneous SAR 200 mg q2w + MTX (n=131).” Conclusion: “Analysis of markers […] showed correlation in MOBILITY patients. These data suggest that multivariate analysis of markers may be necessary to identify increased risk of joint destruction and elevated disease activity in patients with established RA.” And it shows, what isn’ seen – the necessity of results on radiographic progression. But it isn’t a shortcoming of this study.

I’m following the development around sarilumab for a couple of years now. I still hope that the drug comes to the market. But … do we need sarilumab? What could sarilumab give us, which we can’t get from tocilizumab? Will I split up my IL-6 inhibitor patients in two groups? Right now I can’t answer these questions. And still we need data on radiographic progression.

References:

Strand V, Kosinski M, Graham N, Chen CI, Joseph GJ, Bauer D, Lin Y, Pacheco-Tena C, Fleischmann R. Impact of Sarilumab on Fatigue, Pain, Morning Stiffness, Productivity, and Health Related Quality of Life (HRQoL) in Patients with Active Rheumatoid Arthritis Who Were Inadequate Responders or Intolerant of Anti-TNF-α Therapy: Results from a Phase 3 Study (RCT) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/impact-of-sarilumab-on-fatigue-pain-morning-stiffness-productivity-and-health-related-quality-of-life-hrqol-in-patients-with-active-rheumatoid-arthritis-who-were-inadequate-responders-or-intoler/. Accessed November 17, 2015.

Fleischmann R, Castelar-Pinheiro G, Brzezicki J, Hrycaj P, Lin Y, van Adelsberg J, Graham N, van Hoogstraten H, Bauer D, Burmester G. Efficacy and Safety of Sarilumab in Combination with Csdmards in Patients with Active Rheumatoid Arthritis Who Were Inadequate Responders or Intolerant of Anti–TNF-α Therapy: Results from a Phase 3 Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/efficacy-and-safety-of-sarilumab-in-combination-with-csdmards-in-patients-with-active-rheumatoid-arthritis-who-were-inadequate-responders-or-intolerant-of-antiaetnf-i%c2%b1-therapy-results-f/. Accessed November 17, 2015.

Kavanaugh A, Kivitz AJ, Miranda P, Fiore S, Fay J, Fan C, van Adelsberg J, Huizinga TWJ. Efficacy and Safety of Sarilumab Plus MTX in Subgroups of Patients with Rheumatoid Arthritis in a Phase 3 Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/efficacy-and-safety-of-sarilumab-plus-mtx-in-subgroups-of-patients-with-rheumatoid-arthritis-in-a-phase-3-study/. Accessed November 17, 2015.

Genovese MC, Stanislav M, van Hoogstraten H, Martincova R, Fan C, van Adelsberg J. Efficacy of Sarilumab Plus Methotrexate in Achieving Clinical Remission, Using 4 Different Definitions, in Patients with Active, Moderate-to-Severe Rheumatoid Arthritis in a Phase 3 Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/efficacy-of-sarilumab-plus-methotrexate-in-achieving-clinical-remission-using-4-different-definitions-in-patients-with-active-moderate-to-severe-rheumatoid-arthritis-in-a-phase-3-study/. Accessed November 17, 2015.

Dougados M, Choy EH, Kameda H, van Adelsberg J, Fay J, Fiore S, Fan C, Schett G. IL-6R Blockade with Sarilumab Plus Methotrexate Results in Changes in Clinical and Laboratory Parameters Associated with Chronic Inflammation in Patients with Moderate-to-Severe RA in a Phase 3 Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/il-6r-blockade-with-sarilumab-plus-methotrexate-results-in-changes-in-clinical-and-laboratory-parameters-associated-with-chronic-inflammation-in-patients-with-moderate-to-severe-ra-in-a-phase-3-study/. Accessed November 17, 2015.

Strand V, Rendas-Baum R, Joseph GJ, Chen CI, van Hoogstraten H, Huizinga TWJ, Genovese MC. Responder Rates and Numbers Needed to Treat Based on Clinically Meaningful Improvements in Patient Reported Outcomes (PROs) Including Health-Related Quality of Life (HRQoL) after Sarilumab Treatment during a Phase III Randomized Controlled Trial (RCT) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/responder-rates-and-numbers-needed-to-treat-based-on-clinically-meaningful-improvements-in-patient-reported-outcomes-pros-including-health-related-quality-of-life-hrqol-after-sarilumab-treatment-d/. Accessed November 17, 2015.

Emery P, Rondon J, Garg A, van Hoogstraten H, Graham N, Liu M, Parrino J, Spindler AJ, Liu N. Safety and Tolerability of Subcutaneous Sarilumab Compared to Intravenous Tocilizumab in Patients with RA [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/safety-and-tolerability-of-subcutaneous-sarilumab-compared-to-intravenous-tocilizumab-in-patients-with-ra/. Accessed November 17, 2015.

Burmester G, Garg A, van Hoogstraten H, Graham N, Boddy A, Parrino J, Genovese MC. Sarilumab Dose Reduction to Manage Laboratory Abnormalities in an Open-Label Extension Study in RA Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/sarilumab-dose-reduction-to-manage-laboratory-abnormalities-in-an-open-label-extension-study-in-ra-patients/. Accessed November 17, 2015.

Boyapati A, Msihid J, Hamilton JD, Gabay C, Graham N, Fiore S. Evaluation of Bone and Joint Proteins for Prognostic Association with Radiographic Progression and Disease Activity in Methotrexate Inadequate Responder Rheumatoid Arthritis Patients in a Sarilumab Phase 3 Study [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/evaluation-of-bone-and-joint-proteins-for-prognostic-association-with-radiographic-progression-and-disease-activity-in-methotrexate-inadequate-responder-rheumatoid-arthritis-patients-in-a-sarilumab-ph/. Accessed November 17, 2015.

Sarilumab at the EULAR 2014 Meeting in Paris http://rheumatologe.blogspot.de/2014/06/sarilumab-at-eular-2014-meeting-in-paris.html

Secukinumab at the ACR 2015 Meeting in San Francisco

There have been more than 10 publications on secukinumab at the ACR 2015 Annual Meeting in San Francisco. I feel like watching a poker game in the end phase, an all-in-call.

Xenofon Baraliakos and colleagues looked at: “Effect of Interleukin-17A Inhibition on Spinal Radiographic Changes through 2 Years in Patients with Active Ankylosing Spondylitis: Results of a Phase 3 Study with Secukinumab”. Conclusion: “[…]No radiographic progression was observed in ~80% of the pts receiving secukinumab over 104 wks. […]”. Since the tofacitinib debacle concerning EMEA approval, we know how important radiographic data are.

Juergen Braun and colleagues presented: “Secukinumab Significantly Improves Signs and Symptoms of Active Ankylosing Spondylitis: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Loading and Maintenance Dosing”. In conclusions the authors state: “Secukinumab 150 mg s.c. provided sustained improvements over 52 weeks in the signs and symptoms of AS, reducing inflammation, and improving physical function and health-related quality of life. Secukinumab was well tolerated; safety findings were consistent with previous reports.”

The second set of studies is on psoriatic arthritis.

Arthur Kavanaugh and collegues looked at: “Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Psoriatic Arthritis in Anti-TNF-Naive Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Dosing”. Conclusion: “Secukinumab provided sustained improvements in the signs and symptoms of PsA in both anti‒TNF-naïve and anti‒TNF-IR pts.”.

I’ll skip a few interesting studies, but will list these under references.

Alice B. Gottlieb and colleagues presented: “Secukinumab Reduces the Burden of Nail and Skin Disease in Patients with Psoriasis and Patients with Psoriatic Arthritis: Results from Two Phase 3 Studies”. Conclusion: “Secukinumab improved nail and skin symptoms in pts with psoriasis with significant nail involvement and in pts with concomitant PsA and nail involvement.” I guess, we all expected that it would be this way!

And Alice B. Gottlieb also presented: “Secukinumab Improves Skin Symptoms and Physical Functioning Compared with Ustekinumab in Patients with Moderate to Severe Psoriasis with Concomitant Psoriatic Arthritis: Subanalysis of a Randomized, Double Blind, Parallel-Group, Active Comparator-Controlled Phase 3b Trial”. Conclusion: “Secukinumab was superior to ustekinumab at improving skin symptoms in patients with moderate to severe plaque psoriasis. In the small sub-group of patients with psoriasis and concomitant PsA, secukinumab showed a trend for improving skin symptoms and physical functioning compared with ustekinumab.” I must admit that this surprised me.

Laure Gossec an colleagues looked at: “Relationship Between Improvements in Fatigue and Signs & Symptoms of Active Psoriatic Arthritis: a Sub-Analysis of a Phase 3 Study with Secukinumab”. Conclusion: “Secukinumab improved fatigue in patients with active PsA regardless of prior anti-TNF therapy. A relationship between improvement in fatigue and improvements in the signs and symptoms of PsA was only shown for ACR 20 response and not for other assessments of disease. These results suggest that fatigue in PsA is not strongly related to disease activity but was still improved by secukinumab.” I’ll have to look all over the studies if improvement of fatigue has been addressed elsewhere.

Secukinumab is already available under the name Cosentyx in Germany for the indication of moderate to severe plaque psoriasis. In the U.S. Secukinumab had been approved by the FDA even earlier. Now, we rheumatologists have to wait, until FDA and/or EMEA approve the use in psoriatic arthritis, ankylosing spondylitis, and other inflammatory rheumatic conditions. I’ll be happy to have a new tool, though we still don’t know if a certain consecutive order of biologics and the small molecule should be recommended.

PS. Since yesterday (26.11.2015) Cosentyx has been approved in Germany for the indications of psoriatic arthritis and ankylosing spondylitis. So, the waiting is over.

References.

Baraliakos X, Deodhar AA, Braun J, Baeten D, Dougados M, Sieper J, Emery P, Readie A, Martin R, Mpofu S, Richards H. Effect of Interleukin-17A Inhibition on Spinal Radiographic Changes through 2 Years in Patients with Active Ankylosing Spondylitis: Results of a Phase 3 Study with Secukinumab [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/effect-of-interleukin-17a-inhibition-on-spinal-radiographic-changes-through-2-years-in-patients-with-active-ankylosing-spondylitis-results-of-a-phase-3-study-with-secukinumab/. Accessed November 16, 2015.

Braun J, Deodhar AA, Sieper J, Dougados M, Porter B, Andersson M, Richards H. Secukinumab Significantly Improves Signs and Symptoms of Active Ankylosing Spondylitis: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Loading and Maintenance Dosing [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-significantly-improves-signs-and-symptoms-of-active-ankylosing-spondylitis-52-week-results-from-a-randomized-double-blind-placebo-controlled-phase-3-trial-with-subcutaneous-loading-and/. Accessed November 16, 2015.

Kavanaugh A, McInnes IB, Mease PJ, Hall S, Chinoy H, Kivitz AJ, Patekar M, Wang Z, Mpofu S. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Psoriatic Arthritis in Anti-TNF-Naive Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from a Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial with Subcutaneous Dosing [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-psoriatic-arthritis-in-anti-tnf-naive-patients-and-those-previously-exposed-to-anti-tnf-therapy-52-week-results-from-a/. Accessed November 16, 2015.

Mease PJ, McInnes IB, Kirkham B, Kavanaugh A, Rahman P, van der Heijde D, Landewé RBM, Nash P, Pricop L, Wang Z, Mpofu S. Secukinumab Provides Sustained Improvements in Psoriatic Arthritis: 2-Year Efficacy and Safety Results from a Phase 3 Randomized, Double-Blind, Placebo-Controlled Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-psoriatic-arthritis-2-year-efficacy-and-safety-results-from-a-phase-3-randomized-double-blind-placebo-controlled-trial/. Accessed November 16, 2015.

Gottlieb AB, Reich K, Wang Z, Milutinovic M, Mpofu S. Secukinumab Reduces the Burden of Nail and Skin Disease in Patients with Psoriasis and Patients with Psoriatic Arthritis: Results from Two Phase 3 Studies [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-reduces-the-burden-of-nail-and-skin-disease-in-patients-with-psoriasis-and-patients-with-psoriatic-arthritis-results-from-two-phase-3-studies/. Accessed November 16, 2015.

Gottlieb AB, Thaci D, Blauvelt A, Milutinovic M, Mpofu S. Secukinumab Improves Skin Symptoms and Physical Functioning Compared with Ustekinumab in Patients with Moderate to Severe Psoriasis with Concomitant Psoriatic Arthritis: Subanalysis of a Randomized, Double Blind, Parallel-Group, Active Comparator-Controlled Phase 3b Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-improves-skin-symptoms-and-physical-functioning-compared-with-ustekinumab-in-patients-with-moderate-to-severe-psoriasis-with-concomitant-psoriatic-arthritis-subanalysis-of-a-randomized-d/. Accessed November 16, 2015.

Betts KA, Mittal M, Joshi A, Song J, Bao Y. Relative Efficacy of Adalimumab Versus Secukinumab in Active Psoriatic Arthritis: A Matching-Adjusted Indirect Comparison [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/relative-efficacy-of-adalimumab-versus-secukinumab-in-active-psoriatic-arthritis-a-matching-adjusted-indirect-comparison/. Accessed November 16, 2015.

Gossec L, Kvien TK, Conaghan PG, Østergaard M, Cañete JD, Gaillez C, Mpofu S, Sherif B, Jugl S. Relationship Between Improvements in Fatigue and Signs & Symptoms of Active Psoriatic: Arthritis a Sub-Analysis of a Phase 3 Study with Secukinumab [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/relationship-between-improvements-in-fatigue-and-signs-symptoms-of-active-psoriatic-arthritis-a-sub-analysis-of-a-phase-3-study-with-secukinumab/. Accessed November 16, 2015.

Mease PJ, McInnes IB, Gottlieb AB, Widmer A, Pricop L, Mpofu S. Secukinumab Safety and Tolerability in Patients with Active Psoriatic Arthritis and Psoriasis: Results from a Pooled Safety Analysis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-safety-and-tolerability-in-patients-with-active-psoriatic-arthritis-and-psoriasis-results-from-a-pooled-safety-analysis/. Accessed November 16, 2015.

Deodhar AA, Baeten D, Sieper J, Porter B, Widmer A, Richards H. Safety and Tolerability of Secukinumab in Patients with Active Ankylosing Spondylitis: Pooled Safety Analysis of Two Phase 3, Randomized, Controlled Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/safety-and-tolerability-of-secukinumab-in-patients-with-active-ankylosing-spondylitis-pooled-safety-analysis-of-two-phase-3-randomized-controlled-trials/. Accessed November 16, 2015.

Baeten D, Blanco R, Geusens P, Sieper J, Jui-Cheng T, Martin R, Porter B, Richards H. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Ankylosing Spondylitis in Anti-TNF-Naïve Patients and Those Previously Exposed to Anti-TNF Therapy: 52-Week Results from Two Randomized, Double-Blind, Placebo-Controlled Phase 3 Trials [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-ankylosing-spondylitis-in-anti-tnf-naive-patients-and-those-previously-exposed-to-anti-tnf-therapy-52-week-results-from/. Accessed November 16, 2015.

Baeten D, Braun J, Sieper J, Dougados M, Deodhar AA, Baraliakos X, Porter B, Gong Y, Richards H. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Active Ankylosing Spondylitis: 2-Year Efficacy and Safety Results from a Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/secukinumab-provides-sustained-improvements-in-the-signs-and-symptoms-of-active-ankylosing-spondylitis-2-year-efficacy-and-safety-results-from-a-phase-3-randomized-double-blind-placebo-controlled/. Accessed November 16, 2015.