Annals of the Rheumatic Diseases (ARD)Secukinumab in Enthesitis-Related Arthritis and Juvenile Psoriatic Arthritis: A Randomised, Double-Blind, Placebo-Controlled, Treatment Withdrawal, Phase 3 Trial

Secukinumab cuts flare risk by 72% versus placebo in biologic-naive children with ERA and JPsA. The phase 3 trial of 86 patients aged 2 to 17 showed flare rates of 27% versus 55% over two years, with inactive disease achieved in over 40% of secukinumab-treated patients through study completion.

Clinical Considerations

• JIA ACR30 response reached 87.2% by week 12, with onset as early as week 1 in one-third of patients
• JPsA showed stronger response than ERA: 85% versus 55% flare risk reduction, suggesting greater IL-17A pathway dependence in JPsA
• One Crohn’s disease case emerged during the trial; investigators flagged IBD as a potential risk consistent with postmarketing data in adults
• Safety profile over 141.5 patient-years consistent with adult indications; no anti-drug antibodies and only one injection-site reaction detected

Practice Applications

• Consider secukinumab for biologic-naive ERA and JPsA patients with inadequate response to csDMARDs or NSAIDs
• Screen for IBD history and symptoms before initiating; Crohn’s disease emerged in one patient during the trial
• Monitor for uveitis; two new acute anterior uveitis cases occurred, though investigators deemed both unrelated to treatment
• Refer ERA and JPsA patients failing conventional therapy to pediatric rheumatology for biologic evaluation

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