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To the editor: In China, about 10.4% of patients with psoriasis (PsO) have concomitant psoriatic arthritis (PsA).[1] In this population with PsA, polyarticular involvement is the most common feature, along with substantial disease severity and comorbidities,[2] suggesting a significant unmet need in the optimal management of PsA in China.[3] Biologics have considerably changed the treatment landscape for PsA by targeting multiple signaling pathways. Interleukin (IL)-17A antagonism is one such therapeutic approach that selectively targets the predominant pro-inflammatory cytokine of the T-helper 17 (Th17) cell subset.[4] Secukinumab (AIN457) is a high-affinity fully human monoclonal antibody that neutralizes IL-17A activity and an approved therapeutic agent for PsO, PsA, and axial spondyloarthritis (axSpA) in more than 100 countries.[5,6] Secukinumab has demonstrated a sustained long-term efficacy and a consistent safety profile in patients with PsA.[7] In this work, we aimed to report the efficacy and safety of secukinumab versus placebo in Chinese participants with active PsA, intending to compare whether the clinical benefits in these participants are consistent with those observed in global studies (FUTURE 2, FUTURE 3, FUTURE 4, and FUTURE 5).[8–11] This randomized, double-blind, placebo-controlled, parallel-group bridging study (NCT04711902) was conducted across 13 centers in China [Supplementary Figure 1, https://links.lww.com/CM9/C709]. The study protocol was approved by the independent ethics committee or institutional review board of each center [Supplementary Table 1, https://links.lww.com/CM9/C709] and followed International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use E6 guidelines and the Declaration of Helsinki. All enrolled patients have signed informed consent forms. This study enrolled male or non-pregnant, non-lactating female participants aged ≥18 years from China with a PsA diagnosis classified according to the Classification of Psoriatic Arthritis (CASPAR) criteria. Key inclusion and exclusion criteria are presented in Supplementary Table 2, https://links.lww.com/CM9/C709. Eligible Chinese participants were randomized into one of two treatment arms using “Interactive Response Technology,” without stratification. Blinding was maintained for participants, investigators, site personnel, assessors, and monitors until the final database lock, with emergency code breaks permitted solely for participant safety. The primary endpoint was the proportion of participants achieving at least 20% improvement in the American College of Rheumatology (ACR) 20 response at Week 16. The details of ACR measurements are provided in the Supplementary Material, https://links.lww.com/CM9/C709 and endpoints have been presented in Supplementary Table 3, https://links.lww.com/CM9/C709. A planned sample size of 40 participants (20 in each group) was determined using an estimation strategy based on the response rate in the pooled data of four global pivotal studies [Supplementary Material—Sample size calculation, https://links.lww.com/CM9/C709].[8–11] Composite strategy was applied for the intercurrent events of discontinuation from treatment or study before Week 16 in the primary estimand [Supplementary Material—Estimands, https://links.lww.com/CM9/C709]. Supplementary Table 4, https://links.lww.com/CM9/C709, includes details of the statistical analysis. Overall, 41 participants were randomized to either secukinumab 150 mg (N = 20) or placebo (N = 21). At Week 16, all participants were re-randomized to receive secukinumab 150 mg or 300 mg. Three participants discontinued the study: one from the placebo–secukinumab 150 mg group before Week 52 and two from the secukinumab 150 mg–secukinumab 150 mg group during follow-up, based on personal choice [Supplementary Figure 2, https://links.lww.com/CM9/C709]. Baseline disease characteristics were balanced across groups, except for gender and smoking status [Supplementary Table 5, https://links.lww.com/CM9/C709]. At Week 16, the ACR20 response rate was higher with secukinumab 150 mg (14/20; 70.0%) versus placebo (6/21; 28.6%) with model-based difference of 39.9% (95% confidence interval [CI]: 10.87%, 68.95%) [Supplementary Figure 3, https://links.lww.com/CM9/C709]. Pooled global PsA studies showed a difference of 28.3% in ACR20 response rate between secukinumab 150 mg vs. placebo (51.4% [294/572] vs. 23.1% [157/581]), confirming consistent efficacy trends. Secukinumab 150 mg showed consistent efficacy across various disease assessment domains and endpoints. At Week 16, ACR50 response rates were approximately 10% higher with secukinumab than with placebo (15.0% vs. 4.8%). Secukinumab also provided numerically greater improvements from baseline in Disease Activity Score in 28 joints based on C-reactive Protein (DAS28-CRP), Psoriatic Arthritis Disease Activity Score (PASDAS), Health Assessment Questionnaire–Disability Index (HAQ-DI) and Short Form Health Survey–Physical Component Summary (SF-36 PCS) [Supplementary Figure 4A, https://links.lww.com/CM9/C709]. At Week 16, a higher Psoriasis Area and Severity Index 75% improvement (PASI75) response rate was observed in the subset of active PsO (secukinumab 150 mg versus placebo: 66.7% [8/12] vs. 9.1% [1/11]). A similar response rate was observed with Investigator’s Global Assessment modified 2011 (IGA mod 2011) response (41.7% [5/12] vs. 0%). At Week 52, secukinumab 300 mg showed improvements in DAS28-CRP, PASDAS, and SF-36 PCS versus secukinumab 150 mg [Supplementary Figure 4B, https://links.lww.com/CM9/C709]. The observed ACR20 and ACR50 response rates are shown in Supplementary Figures 5A and 5B, https://links.lww.com/CM9/C709, respectively. ACR50 response rates improved in the “secukinumab 150 mg–300 mg” group from Week 16 to Week 52 after dose escalation. Great reductions in DAS28-CRP, PASDAS, and HAQ-DI and great improvement in SF-36 PCS were seen with 150 mg or 300 mg [Supplementary Figure 6A–D, https://links.lww.com/CM9/C709]. However, results should be interpreted with caution due to the small sample size. Participants in placebo group were switched to secukinumab (150 mg or 300 mg) at Week 16, resulting in shorter exposure (placebo vs. secukinumab: 112 days vs. 326 days). At Week 16, the incidence of treatment-emergent adverse events (TEAEs) was similar between groups (secukinumab 150 mg: 85.0% [17/20] vs. placebo: 76.2% [16/21]). At Week 52, TEAEs were reported in 90.2% (37/41) of participants in the group treated with any secukinumab, with an exposure-adjusted incidence rate (EAIR) of 261.2 per 100 subject-years. Common TEAEs by system organ class were metabolism/nutrition disorders (62.0 per 100 subject-years) and infections/infestations (56.0 per 100 subject-years; mainly COVID-19-related). The most frequently reported TEAEs in the group treated with any secukinumab were hyperlipidemia (27.2 per 100 subject-years), hyperuricemia (25.6 per 100 subject-years), and COVID-19 (23.2 per 100 subject-years; Supplementary Table 6, https://links.lww.com/CM9/C709). At Week 52, in the group treated with any secukinumab, mild TEAEs were reported in 68.3% (28/41) and moderate TEAEs in 22.0% (9/41) (12.2% [5/41] infections and infestations) participants. No severe adverse events (AEs) were reported. Treatment-related AEs were reported in 53.7% (22/41) participants and the most common treatment-related AEs (≥10.0%) were hyperlipidemia (14.6%, 6/41) and hyperuricemia (12.2%, 5/41). Five participants (12.2%, 5/41) had temporary dose interruptions due to AEs in the group treated with any secukinumab (secukinumab 150 mg: lymphangitis and skin infection; secukinumab 300 mg: blepharitis, COVID-19, and suspected COVID-19). Overall, nine participants were reported to have COVID-19 during the study and five participants had suspected COVID-19. These events were mild or moderate in severity and all resolved (two resolved with sequelae). No significant abnormalities related to hematology, clinical chemistry, vital signs, or electrocardiogram evaluations were reported. No deaths or AEs leading to discontinuation of study treatment occurred. This study demonstrated sustained efficacy of secukinumab in Chinese participants with PsA. At Week 16, greater ACR20 improvements and more benefits across most disease domains were observed in the secukinumab group than in the placebo group. Dose escalation from 150 mg to 300 mg led to greater improvements in symptoms of arthritis (ACR50, DAS28-CRP, and PASDAS) and quality of life (SF-36 PCS and HAQ-DI). These results align with findings from global studies, where 300 mg demonstrated faster onset, better efficacy, and meaningful improvements versus 150 mg.[8–11] Overall, safety outcomes observed in the Chinese population showed no new safety signals. All participants in the 300 mg group completed treatment, with no significant safety differences between the 150 mg and 300 mg doses. Switching from placebo to secukinumab revealed no new safety concerns, consistent with secukinumab’s established long-term safety across indications.[12] The limitations of this study include small sample size, resulting in descriptive presentation of data and limited capacity to detect rare AEs. As a bridging study to assess the applicability of global findings to China, small sample size may have led to lack of statistical power to generalize the results. Therefore, the results should be interpreted with caution. The COVID-19 pandemic also impacted analyses of a few efficacy indicators, with two participants missing the Week 16 visit; however, the primary and key secondary endpoints were minimally affected. Given the need for advanced PsA treatments in China, these findings hold utmost importance. Secukinumab demonstrated sustained efficacy from Weeks 16 to 52, aligned with the results from global studies. Dose escalation to 300 mg and switching from placebo to secukinumab 300 mg led to improved outcomes. Both doses were well-tolerated, with a consistent safety profile. Acknowledgments The authors thank the patients who participated in the study and the study investigators for providing medical guidance and editorial support. Medical writing support, under the guidance of the authors, was provided by professional medical writers, Sivaram Vedantam (PhD) and Ishita Guha Thakurta (PhD). Sivaram Vedantam was employed as Expert Scientific Writer at Novartis Healthcare Pvt. Ltd. (India) and Ishita Guha Thakurta is an employee of Novartis Healthcare Pvt. Ltd. (India). Conflicts of interest Mercedes Bustamante, Sharonjeet Kaur, Rong Fu, Yuan Tian, Jing Yang, and Pellet Pascale are employees of Novartis and own stocks of Novartis. The study was sponsored by Novartis Pharma AG, Basel, Switzerland. Medical writing support was funded by Novartis.