One‐Year Treatment Outcomes of Secukinumab Versus Tumor Necrosis Factor Inhibitors in Spondyloarthritis: Results From Five Nordic Biologic Registries Including More Than 10,000 Treatment Courses

Abstract

Register of Biological Treatment (ROB-FIN), and Norwegian Antirheumatic Drug Register (NOR-DMARD) registriesObjective. To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA) using adalimumab as the main comparator.Methods. This was an observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis, nonradiographic axial SpA, or undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from 5 Nordic clinical rheumatology registries. Data on comorbidities and extraarticular manifestations (psoriasis, uveitis, and inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios [HR adj ] for treatment discontinuation) and 6-month response rates (Ankylosing Spondylitis Disease Activity Score [ASDAS] score <2.1, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] <40 mm, crude/LUNDEX-adjusted, adjusted logistic regression analyses with odds ratios [ORs]) stratified by line of biologic treatment (first, second, and third plus).Results. In total, 10,853 treatment courses (842 secukinumab and 10,011 TNFi, of which 1,977 were adalimumab) were included. The proportions of patients treated with secukinumab during the first, second, and third-plus lines of treatment were 1%, 6%, and 22%, respectively). Extraarticular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a 1-year retention comparable to adalimumab as a first or second line of treatment but poorer as a third-plus line of therapy (secukinumab 56% [95% confidence interval (95% CI) 51-61%] versus adalimumab 70% [95% CI 64-75%]; HR adj 1.43 [95% CI 1.12-1.81]). Across treatment lines, secukinumab had poorer estimates for 6-month response rates than adalimumab, statistically significantly only for the third-plus line (adjusted analyses: ASDAS score <2.1 OR 0.56 [95% CI 0.35-0.90]; BASDAI <40 mm OR 0.62 [95% CI 0.41-0.95]). Treatment outcomes varied across the 5 TNFi.Conclusion. Secukinumab was mainly used in biologics-experienced patients with SpA. Secukinumab and adalimumab performed similarly in patients who had failed a first biologic, although with increasing prior biologic exposure, adalimumab was superior.

Anterior uveitis in patients with spondyloarthritis treated with secukinumab or tumour necrosis factor inhibitors in routine care: does the choice of biological therapy matter?

“…1 Randomised controlled trials (RCTs) of treatment of axSpA typically focus on axial disease activity, [2][3][4] where the effect appears to be similar across the different tumour necrosis factor inhibitors (TNFi). 5 For secukinumab and ixekizumab, indirect comparison of the results from their pivotal RCTs, together with a large observational study, 6 suggest that the effect of interleukin 17-inhibitors (IL-17i) on axial disease is in line with that of TNFi. 2 3 7 Whereas the effects on axial disease may be similar, the effects on other SpA manifestations seem to vary substantially.…”

A Pooled Analysis Reporting the Efficacy and Safety of Secukinumab in Male and Female Patients with Ankylosing Spondylitis

“…Secukinumab, an interleukin (IL)-17A inhibitor, has demonstrated sustained improvement in the signs and symptoms of active AS in the MEASURE clinical trial program [5,6,12,14,15]. The impact of sex on the efficacy of secukinumab has not been thoroughly evaluated and although comparative effectiveness in the real-world setting between TNFi and secukinumab has been previously reported, stratification by sex was not investigated further [16,17]. In this post hoc analysis, we report efficacy and safety data pooled from five phase 3 MEASURE studies with respect to sex in patients with active AS treated with secukinumab through 52 weeks.…”

Evidence for the Use of Secukinumab in Patients with Radiographic and Non-radiographic Axial Spondyloarthritis in the Last 5 Years

“…6 ) [ 58 , 59 , 63 , 64 ]. Retention was highest when secukinumab was used as the first biological agent (76–84% at 12 months), but decreased with subsequent lines of treatment (67–75% as second-line biological and 56–66% as third-line) [ 58 , 65 , 66 ]. The most common reason for treatment discontinuation in these real-world studies was insufficient efficacy [ 58 , 59 , 63 , 66 ], and data from EuroSpA showed that this was also the most common reason for discontinuing TNF inhibitor therapy [ 58 ].…”