Reviews/Psoriasis Psoriatic Arthritis/Secukinumab 5-year ACR20 durability
Psa PJT · PSA-PJT-02 · v2
Borderline: within 4 points of the Established/Likely boundary, so a re-grade could land either side.
Two separate large trials of secukinumab in psoriatic arthritis followed patients out to five years and found that most of those still on the drug kept the joint-symptom improvement they had gained early on. In one trial about 74% of patients on the higher dose still met the standard ACR20 improvement mark at year five [1], and in a second, independent trial the figure was 71.0% [3]. Shorter checkpoints at two [2] and three [8] years, plus a five-year breakdown by prior treatment history [5], show the response holding steadily rather than resting on one lucky measurement. The main caveat the panel weighed is that these five-year figures count only patients who stayed on treatment, not everyone who started, so they describe how well responders held up rather than the odds any given starter reaches year five. Because the claim is specifically about continuous therapy, the panel judged that this caveat is bounded rather than fatal, and the fact that two independent trials agree so closely is what carried the assessment.
Two independent phase 3 pivotal trials report a discrete five-year ACR20 rate that converges tightly: 74% on 300 mg and 70% on 150 mg among 96 evaluable patients in FUTURE 2 [1], and 71.0% in FUTURE 1 [3], where 81.8% of the 150 mg group completed five years. The trajectory is populated rather than a single endpoint: ACR20 was 69.4%/64.4% at week 104 [2] and 75.3%/69.9% at week 156 [8]. A five-year subgroup analysis shows the response holding across treatment history, with 79.6% and 77.1% of TNFi-naive patients responding at Week 260 [5]. The pivotal short-term trial [9] anchors the initial placebo-controlled response that the extensions sustain. The contested point: The division is over the denominator: the five-year rates are drawn from patients still evaluable and on drug [1], [3], not from an intent-to-treat baseline, so they measure durability among continuers rather than among all starters. The panel divides on how far the claim's 'continuous therapy' wording absorbs this, versus how far a reader could over-read the headline percentage.
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One reviewer's only job is to attack the finding. The challenges below were weighed before the grade was set.
The 5-year ACR20 rates in [1] (74%, '96 evaluable patients') and [3] (71.0%, 81.8% completed) are completer/evaluable-population figures, not intent-to-treat from baseline; attrition removes non-responders from the denominator and inflates apparent durability.
Analysis methods differ across timepoints — [2] uses multiple imputation while [1] and [3] report observed/evaluable rates without stated imputation — so cross-timepoint 'sustained' comparisons are not method-consistent.
Where it remains uncertain. Five-year rates are computed among evaluable/completing patients [1], [3], not from an intent-to-treat baseline, so they reflect response among continuers rather than durability from the start of therapy.
Aleatory
The 300 mg five-year rate rests on 96 evaluable patients [1], so chance variation in a shrinking population widens the plausible range of the true durable-response rate.
The load-bearing papers from a corpus of 9, each classified by what it does to the claim. Every DOI is taken from the corpus the claim was graded on.
Primary 5-year ACR20 evidence from FUTURE 2.
“ACR responses at 5 years were 74% (ACR20), 52% (ACR50), and 32% (ACR70) of 96 evaluable patients in the secukinumab 300 mg group, and 70% (ACR20), 43% (ACR50), and 29% (ACR70) in the 150 mg group.”
Panel auditInternal validity: medium · scope of inference: Secukinumab-treated active psoriatic arthritis patients remaining on therapy to 5 years in FUTURE 2.Key limitations: no comparator at 5 years · survivor/completer population · missing-data handling not stated in abstract
2-year timepoint anchoring the durability trajectory.
“At week 104, ACR20 response rates after multiple imputation in the 300, 150 and 75 mg groups were 69.4, 64.4 and 50.3%, respectively.”
Panel auditInternal validity: medium · scope of inference: Secukinumab-treated active psoriatic arthritis patients through 2 years in FUTURE 2, including anti-TNF-experienced.Key limitations: 2-year window, not 5 · no comparator · sample size not reported
Independent replication of 5-year ACR20 durability in FUTURE 1.
“Overall, 81.8% of patients in the secukinumab 150-mg group completed 5 years. Sustained improvements were achieved across all key efficacy endpoints through 5 years; 71.0%/51.8%/36.3% of patients achieved ACR20/50/70 responses at 5 years.”
Panel auditInternal validity: medium · scope of inference: Secukinumab 150 mg-treated active psoriatic arthritis patients remaining on therapy to 5 years in FUTURE 1.Key limitations: no comparator at 5 years · completer/survivor population · absolute N not reported
3 of 9 papers shown. The full review lists all of them, with the panel’s arbitration →
Claims are graded at each quarterly release, and re-graded between releases only when a pivotal trial lands. Every change is a new version of the claim.
Replicated, on-target 5-year ACR20 data from two independent pivotal RCTs carries the claim, held to the Established floor by the completer-analysis attrition caveat.
Release 2026-q4 re-graded every claim from its corpus under protocol v0.19. An earlier release's grade is shown for the record; it came from an earlier protocol and is not a movement.
Assumptions that carry weight but are not themselves established.
The panel records the gap that would most move the claim, and the study that would close it.
Intent-to-treat five-year durability. Every five-year rate here is evaluable-population based [1], [3], so the response rate referenced to all randomised starters is unknown, which is exactly where a reader is most likely to over-read. The panel rates this the highest-importance open gap for the claim, and names the study design that would close it: Re-analyse the FUTURE 1 and FUTURE 2 five-year datasets on a non-responder-imputation or full intent-to-treat basis and report the ACR20 rate against the original randomised denominator.
Open question: What is the five-year ACR20 rate when computed from the original randomised baseline rather than the evaluable population? Why it is still open: The corpus reports only evaluable/completing-population rates at five years [1], [3], leaving intent-to-treat durability unstated.
Priors is a sceptical first reader, not peer review, and not medical advice.
Release 2026-q4 · graded 18 Sep 2026 · protocol v0.19