Background/Purpose: Secukinumab (SEC) is licensed to treat adults with spondyloarthritis and psoriatic arthritis. It is not licensed for juvenile patients yet.  As biologic agents up till now only etanercept and adalimumab are licensed for enthJIA.  Not all enthJIA patient reaching remission with an anti-TNF therapy.  We review our patients, who did not reach remission under anti-TNF and were switched to SEC.

Methods: We conducted a retrospective monocentric chart review of patients with enthJIA, who were ever treated with SEC with enthJIA, at least for 3 months till 15^thof March 2019.   We used the JADAS10 and the Juvenile Spondyloarthritis Disease Activity Index (jspADA) [1]to evaluate response.

Results: 17 patients with enthJIA were treated till 15^thof  March 2019. 77 % were female.   The mean age of the patients at the start of the treatment was 19.5 years. The mean disease duration was 6.3 years.  The patients received in average 1.9 different anti-TNF´s before switching to SEC. The JADAS-10 was 8.3 and the jspADA 2.4 at the time initiation of SEC.  SEC was applied according the adult dosing schedule, the mean weight of the patients was 65 kg.  The mean dose at week 0 was 185 mg/dose, at 12 months 270 mg/dose (n=15) and at 24 months 280mg/dose (n=9).  Mean follow up of the patients under SEC was18months.  JADAS 10 dropped from 8.35 at timepoint 0 to 5.8 at 3 months (n=17 ); 5.1 at 6 months (n=16), 5.5 at  12 months  (n=15) and to 6.5 at 24 months (n=9) .   jspADA, a more sensitive outcome parameter for enthJIA dropped from 2.41 at timepoint 0 to 1.6 at 3 months  (n=17 ); 1.7 at 6 months (n=16), 1.2 at 12 months (n=15)and to 1.3 at 24 months (n=9) .  In two patients SEC after 24 months was switched to tofacitinib, because of nonresponse.  There was no SAE observed.

Conclusion: In our anti-TNF nonresponder patients SEC showed quite good effectiveness regarding the improvement in jspADA and less in JADAS 10, which is less specific for enthJIA.  The 150 mg dose seems to be not sufficient in anti-TNF nonresponder patients, in most of the patients the dose had to be increased to 300 mg /dose per application.  

References

1. Weiss, P.F., et al., Development and retrospective validation of the juvenile spondyloarthritis disease activity index.Arthritis Care Res (Hoboken), 2014. 66(12): p. 1775-82.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/secukinumab-is-a-promising-treatment-for-patients-with-juvenile-enthesitis-related-arthritis-nonresponsive-to-anti-tnf-treatment-according-the-juvenile-spondyloarthritis-disease-activity-index/