Novartis announced that the US Food and Drug Administration (FDA) has approved Cosentyx (secukinumab) for the treatment of two new indications - adults with active ankylosing spondylitis (AS) and active psoriatic arthritis (PsA). AS and PsA are both life-long, painful and debilitating inflammatory diseases that affect the joints and/or spine. If not treated effectively, both conditions can lead to irreversible joint and/or spinal bone damage caused by years of inflammation.

Cosentyx is the first in a new class of medicines called interleukin-17A (IL-17A) inhibitors to treat both AS and PsA. The two new indications follow the earlier FDA approval for Cosentyx in January 2015 to treat adult patients with moderate-to-severe plaque psoriasis, and European approval for AS and PsA in November 2015.

"These new approvals are a potential turning point for people living with ankylosing spondylitis and psoriatic arthritis in the US, as Cosentyx provides a novel and targeted way of inhibiting the inflammatory process of these two conditions," said David Epstein, division head, Novartis Pharmaceuticals. "The results from our studies have shown that the majority of patients treated with Cosentyx have a significant reduction in their signs and symptoms of ankylosing spondylitis and psoriatic arthritis, and show major improvements in their ability to undertake everyday activities."

In the US, it is estimated that up to 0.5 per cent of the population have AS, and up to 1 per cent live with PsA. If not treated effectively, these conditions can lead to irreversible damage to the spine and joints, causing life-long pain and disability that can have a negative impact on even simple tasks in life. There is an urgent unmet need for new medicines for these conditions. Currently, many patients are dissatisfied with their treatments, and up to 40 per cent do not respond sufficiently to anti-tumour necrosis factor-alpha (anti-TNFs) therapy.

The approvals are based on the efficacy and safety outcomes from four placebo-controlled phase III studies, which included over 1,500 adult patients with AS or PsA that were biologic treatment naïve or had an inadequate response / were intolerant to anti-TNFs. In the studies, Cosentyx met the primary endpoints achieving statistically significant improvements versus placebo in the signs and symptoms of AS and PsA, as measured by at least a 20 per cent improvement in the Assessment of Spondyloarthritis International Society criteria (ASAS 20) at week 16, and a 20 per cent reduction in the American College of Rheumatology (ACR 20) response criteria at week 24, respectively. ASAS 20 and ACR 20 are standard tools used to assess clinical improvement in AS and PsA.

More than 9,600 patients have been treated with Cosentyx in clinical trials across multiple indications, and over 15,000 patients with psoriasis have already been treated in the post-marketing setting. The safety profile of Cosentyx was shown to be consistent with that seen in clinical trials across multiple indications.

Ankylosing spondylitis (AS) is painful and often progressively debilitating, caused by spine inflammation that can result in irreversible damage. Up to 70 per cent of patients who go on to develop severe AS will form spinal fusions (where the bones grow together) over 10 to 15 years, which significantly reduces mobility. People aged 25 or older, particularly males, are affected most often. Family members of those with AS are at higher risk. Approximately 20-40 per cent of patients do not respond well to standard of care biologic medicines, and there are few therapeutic options available to those people.

Psoriatic arthritis (PsA) is an inflammatory condition of the joints and is often associated with a scaly skin condition called psoriasis. Symptoms include joint pain and stiffness, skin and nail psoriasis, swollen toes and fingers and persistent painful enthesitis (inflammation of the sites where tendons or ligaments insert into the bone). Up to 40 per cent of people can suffer from joint destruction and permanent physical deformity. Up to 15 per cent of people with psoriasis may have undiagnosed PsA. As many as 30 per cent of patients with psoriasis will have PsA.

New medicines are needed as many patients do not respond to, or tolerate, current therapies and approximately 45 per cent of PsA patients are dissatisfied with treatments.

Pivotal phase III studies in the Cosentyx clinical trial programme, that provided key data for the submission, were MEASURE 1 and MEASURE 2 involving 590 patients with AS, and FUTURE 1 and FUTURE 2 including 1,003 patients with PsA. Data from these pivotal trials were published in the New England Journal of Medicine and The Lancet. These are multi-center, randomized, placebo-controlled studies designed to evaluate the efficacy and safety of Cosentyx in AS and PsA. Additional follow-up of patients from these trials is still ongoing. Novartis continues to investigate Cosentyx for its potential role in preventing radiographic progression of spinal and joint structural damage in AS and PsA patients respectively, as shown by x-ray.

Cosentyx is a fully human monoclonal antibody that selectively neutralizes circulating IL-17A. Research suggests that IL-17A may play an important role in driving the body's immune response in psoriasis, PsA and AS. Cosentyx is the first IL-17A inhibitor with positive phase III results for the treatment of PsA and AS, and is now approved in Europe and the US for these conditions. Cosentyx is approved for the treatment of AS and PsA in Ecuador and Bangladesh, and for the treatment of PsA in Japan.

In addition, over 50 countries have also approved Cosentyx for the treatment of moderate-to-severe plaque psoriasis which includes the European Union countries, Japan, Switzerland, Australia, the US and Canada. In Europe, Cosentyx is the only first-line biologic approved for the systemic treatment of moderate-to-severe plaque psoriasis in adult patients. In the US, Cosentyx is also approved as a treatment for moderate-to-severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy (light therapy).