For a study, researchers sought to compare the effectiveness of secukinumab (SEC) 300 mg and 150 mg against a placebo in a group of psoriatic arthritis (PsA) patients who had never taken a biologic.

CHOICE was a randomized controlled experiment that was double-blind and carried out in the US. Patients with PsA and psoriasis (PsO) who had never taken a biologic were randomized 2:2:1 to receive SEC 300 mg (n=103), SEC 150 mg (n=103), or a placebo (n=52). The main goal was to demonstrate that SEC 300 mg was better than placebo at week 16 in terms of the American College of Rheumatology 20% (ACR20) response. The impact of SEC on dactylitis, enthesitis, PsO, and safety were additional goals.

At week 16, SEC 300 mg had greater ACR20 response rates than placebo (51.5% vs. 23.1%; odds ratio, 3.51 [95% CI, 1.65-7.45]; P=0.001). In comparison to the placebo, SEC 300 mg produced better ACR50/70 responses as well as improvements in other measures. In general, responses persisted throughout time. Patients who underwent dosage escalation to 300 mg after responding insufficiently to SEC 150 mg at weeks 16, 28, or 40 showed better clinical response. Infections of the upper respiratory tract and diarrhea were the most frequent side effects. No new safety signals or cases of inflammatory bowel disease were recorded.

In the more substantial group of US-only, biologic-naive patients, SEC 300 mg quickly reduced PsA symptoms compared to placebo. The results were in accordance with other research and indicate that SEC 300 mg is a safe and effective first-line biologic therapy for PsA patients.

Reference: jrheum.org/content/49/8/894