One-year effectiveness, retention rate, and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a real-life multicenter study

Abstract

Background: Secukinumab (SEC) is effective for ankylosing spondylitis (AS) and psoriatic arthritis (PsA) in randomized trials, but real-life data are lacking. Research design and methods: Real-life, prospective observational study on 169 consecutive outpatients at baseline (T0) and at 6 (T6) and 12 months (T12) after starting SEC (39 AS, 23%; 130 PsA, 77%). Results: Significant improvement was seen at T6 and T12 for all clinical variables, including TJC, SJC, ESR, CRP, DAPSA, ASDAS-CRP, and BASDAI, as well as in patient-reported outcomes like VAS-pain. By multivariable regression analysis, in AS patients high BASDAI at T0 correlated with diagnostic delay (R 2 = 0.4; p = 0.009) and peripheral joint involvement (R 2 = 0.4; p = 0.04). During follow-up, reduction of BASDAI positively correlated with high ESR (R 2 = 0.65; p = 0.04). ASDAS-CRP at T0 positively correlated with high ESR (R 2 = 0.34; p = 0.004). Reduction of ASDAS-CRP from T0 to T6 correlated with current smoking status (R 2 = 0.42; p = 0.003). In PsA patients, reduction of DAPSA score from T0 to T12 is negatively correlated with the presence of metabolic syndrome (R 2 = 0.41; p = 0.0025). SEC was well tolerated; 10 patients discontinued treatment for non-severe adverse events. Conclusions: Secukinumab is effective and safe in patients with AS and PsA in a real-life setting.

From observational studies to personalized treatment in spondylarthritis: focus on IL-17 inhibition

“…Some of these, such as IBD, demyelinating diseases, latent TB, could play an important role in personalized treatment. The work presented here [6] on secukinumab shows small differences with other similar studies [7,8], especially concerning the impact of the treatment line. Differences in the numbers and heterogeneity of patients included in these different studies may be a beginning of explanation of this discrepancy.…”

“…In a recent issue of Expert Opinion on Biological Therapy [6], authors evaluated effectiveness, retention rate, and safety of secukinumab, an anti-IL17A monoclonal antibody, over 1 year in 169 patients with SpA (ankylosing spondylitis and psoriatic arthritis, PsA). This real-life observational study brings confirmation of secukinumab's efficacy in the several phenotypic forms of SpA with different evaluation tools.…”

“…The results of the work presented in Expert Opinion on Biological Therapy [6] are a contribution to the development of therapeutic strategies in a disease such as spondyloarthritis, with a large clinical and paraclinical polymorphism and a broadening of the range of possible therapeutic options. In this context, the idea is to provide the right treatment for the right patient (and at the right time).…”

<p>An Update for the Clinician on Biologics for the Treatment of Psoriatic Arthritis</p>

“…We recently evaluated gender influence in PsA patients treated with UST and in PsA patients treated with SEC: gender did not influenced the efficacy of SEC nor the efficacy of UST. 14,79 The presence of moderate-to-severe skin or nails PsO in "difficult areas" benefits treatment with inhibitors of Il-17 and IL-23 drug axes. 3 However, the same superiority in treating articular and axial manifestations in PsA or in radiographic progression is still missing.…”

“…Moreover, the SEC retention rate was not influenced by Body Mass Index (BMI) or gender, supporting that another mechanism of action other than TNFi may be effective in overweight patients and in women. 79 In a recent long-term safety analysis, SEC was associated with a generally low frequency of AEs, with higher incidence of URTI. As expected with IL-17 inhibition, cases of candidiasis were observed given that Th-17 cells play an important role in skin and mucous host defense, particularly against fungi and extracellular bacteria.…”