Do Smoking and Obesity Impact Secukinumab Treatment Outcomes? Real-world Data from 1,202 European Patients with Psoriatic Arthritis

Zohra Faizy Ahmadzay¹, Stylianos Georgiadis², Mikkel Ostergaard³, Bente Glintborg⁴, Signe Møller-Bisgaard⁵, Marion Pons⁶, Jette Heberg⁷, Sara Nysom Christiansen⁸, Simon Horskjær Rasmussen⁶, Anne Gitte Loft⁹, Isabel Castrejon¹⁰, Lucia Otero-Varela¹¹, Jakub Závada¹², Karel Pavelka¹², Jarno Rutanen¹³, Laura Kuusalo¹⁴, Michael Nissen¹⁵, Ziga Rotar¹⁶, Katja Perdan-Pikmajer¹⁶, Miguel Bernardes¹⁷, Bjorn Gudbjornsson¹⁸, Gerdur Gröndal¹⁸, Irene E. van der Horst-Bruinsma¹⁹, Karin Laas²⁰, Brigitte Michelsen²¹, Catalin Codreanu²², Daniela DiGuiseppe²³, Burkhard Moeller²⁴, Gökçe Kenar²⁵, Merete Hetland²⁶ and Lykke Oernbjerg², ¹Rigshospitalet Glostrup and Copenhagen University, Glostrup, Denmark, ²Rigshospitalet Glostrup, Glostrup, Hovedstaden, Denmark, ³Department of Clinical Medicine, University of Copenhagen and Center for Rheumatology, Copenhagen Center for Arthritis Research, Glostrup, Denmark, ⁴DANBIO, Rigshospitalet Glostrup and University of Copenhagen, Virum, Denmark, ⁵Rigshospitalet, Glostrup and Slagelse Hospital, Glostrup, Denmark, ⁶Rigshospitalet Glostrup, Glostrup, Denmark, ⁷Rigshospitalet Glostrup, København V, Denmark, ⁸Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark., Glostrup, Denmark, ⁹Aarhus University Hospital and Aarhus University, Horsens, Denmark, ¹⁰Hospital General Universitario Gregorio Marañón and Complutense University of Madrid, Madrid, Spain, ¹¹Spanish Society of Rheumatology, Madrid, Spain, ¹²Institute of Rheumatology and Charles University, Praha, Czech Republic, ¹³Tampere University Hospital, Tampere, Finland, ¹⁴University of Turku and Turku University Hospital, Turku, Finland, ¹⁵Geneva University Hospital, Geneva, Switzerland, ¹⁶University Medical Centre Ljubljana and University of Ljubljana, Ljubljana, Slovenia, ¹⁷São João Hospital Center and FMUP, Lisboa, Portugal, ¹⁸Landspitali University Hospital and University of Iceland, Reykjavik, Iceland, ¹⁹Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands, ²⁰East-Tallinn Central Hospital, Tallinn, Estonia, ²¹Rigshospitalet, Glostrup and Diakonhjemmet Hospital and Sørlandet Hospital, Kristiansand, Norway, ²²University of Medicine and Pharmacy, Bucharest, Romania, ²³Karolinska Institutet, Stockholm, ²⁴Inselspital - University Hospital Bern, Bern, Switzerland, ²⁵Dokuz Eylul University School of Medicine, Izmir, Turkey, ²⁶Rigshospitalet Glostrup and University of Copenhagen, Glostrup, Denmark

Meeting: ACR Convergence 2024

Keywords: Disease-Modifying Antirheumatic Drugs (Dmards), obesity, Psoriatic arthritis, registry, Smoking

Session Information

Date: Monday, November 18, 2024

Title: SpA Including PsA – Treatment Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Smoking and obesity are common in patients with psoriatic arthritis (PsA) and can lead to higher disease activity and poorer response to treatment with Tumor Necrosis Factor inhibitors (TNFi). Few studies have investigated the impact of these factors on secukinumab (an interleukin 17A inhibitor, IL-17Ai) treatment outcomes. In this study, we investigated secukinumab treatment outcomes in routine care patients with PsA and their association with smoking status and Body Mass Index (BMI) class.

Methods: Patients with PsA, as diagnosed by their treating physician, initiating secukinumab between 2015 and 2020 with available data on smoking status and BMI were identified in eight European registries participating in the European Spondyloarthritis (EuroSpA) research collaboration. Patients were stratified according to smoking status (never, former, current) and BMI class (normal [18.5 kg/m² ≤ BMI < 25 kg/m²], overweight [25 ≤ BMI < 30], obese [BMI ≥30]) at treatment start (baseline). The 12-month secukinumab retention rates were estimated with Kaplan-Meier curves and compared with Cox regression across smoking status and BMI class, respectively. The proportion of patients achieving Disease Activity index for Psoriatic Arthritis in 28 joints (DAPSA28) low disease activity (LDA) after 6 months of treatment was calculated and compared with logistic regression. All models were adjusted for baseline age, sex, country’s gross domestic product, time since diagnosis, line of treatment with biologic/targeted disease-modifying antirheumatic drugs, and BMI/smoking status depending on stratification. Missing baseline covariates and DAPSA28 at 6 months were imputed using multiple imputations with chained equations.

Results: A total of 1,202 patients were included, the baseline characteristics are shown in Table 1. The 12-month secukinumab retention rates were 79%/73%/72% in never/former/current smokers and 72%/77%/77% in normal-weight/overweight/obese patients, respectively, Figures 1A and 2A. Former and current smokers had a ≈30% increased risk of treatment withdrawal compared with never smokers, while overweight and obese patients had a ≈10% decreased risk compared to normal weight, Figures 1B and 2B. However, no significant differences in hazard ratios were found. The 6-month LDA rates were 56%/64%/51% in never/former/current smokers and 60%/60%/51% in normal-weight/overweight/obese patients, respectively. The odds of achieving DAPSA28 LDA after 6 months were ≈30% higher in former smokers and ≈25% lower in current smokers compared with never smokers, while the odds were equal in overweight and ≈25% lower in obese patients compared with normal-weight. However, no significant differences were found in the odds ratios, Figures 1C and 2C.

Conclusion: In PsA, former and current smokers appeared to have approximately 30% increased risk of withdrawing from secukinumab treatment within 12 months compared with never smokers, whereas, we found no evidence of an impact of BMI class. Neither smoking status nor BMI class were associated with the odds of achieving DAPSA28 LDA after six months. Our findings suggest that smoking impacts the retention of IL-17Ai, similar to what has been demonstrated for TNFi.

Table 1 Baseline characteristics of patients stratified according to smoking status and BMI class.

Figure 1 Secukinumab treatment outcomes stratified by smoking status A. Kaplan-Meier curves B. Forest plots of Cox regression analyses* of 12-month retention rates with hazard ratios (HR), and C. Forest plots of logistic regression analyses* of DAPSA28 low disease activity achievement after 6 months with odds ratios (OR). *Adjusted for baseline age, sex, country’s gross domestic product, time since diagnosis, line of treatment with biologic/targeted disease-modifying antirheumatic drugs, and BMI.

Figure 2 Secukinumab treatment outcomes stratified by BMI class A. Kaplan-Meier curves B. Forest plots of Cox regression analyses* of 12-month retention rates with hazard ratios (HR), and C. Forest plots of logistic regression analyses* of DAPSA28 LDA achievement after 6 months with odds ratios (OR). *Adjusted for baseline age, sex, country’s gross domestic product, time since diagnosis, line of treatment with biologic/targeted disease-modifying antirheumatic drugs, and smoking status.

Disclosures: Z. Ahmadzay: Novartis, 5, UCB, 5; S. Georgiadis: Novartis, 5, UCB, 5; M. Ostergaard: Abbott, 2, 5, 6, BMS, 6, Centocor, 5, Merck, 2, 6, Mundipharma, 6, Pfizer, 2, 5, 6, Roche, 2, UCB Pharma, 2, 6; B. Glintborg: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Pfizer, 5, Sandoz, 5; S. Møller-Bisgaard: None; M. Pons: Novartis, 5, UCB, 5; J. Heberg: Novartis, 5, UCB, 5; S. Christiansen: Novartis, 5; S. Rasmussen: Novartis, 5; A. Loft: AbbVie/Abbott, 2, 6, Eli Lilly, 2, 6, Janssen, 2, 6, Novartis, 2, 5, 6, Pfizer, 2, 6, UCB, 2, 6; I. Castrejon: None; L. Otero-Varela: None; J. Závada: AbbVie/Abbott, 1, AstraZeneca, 6, Eli Lilly, 6, Sanofi, 6, Sobi, 6, UCB, 6; K. Pavelka: AbbVie/Abbott, 6, Bristol-Myers Squibb(BMS), 6, Eli Lilly, 6, Merck/MSD, 6, Novartis, 6, Pfizer, 6, UCB, 6; J. Rutanen: None; L. Kuusalo: None; M. Nissen: AbbVie/Abbott, 2, 6, Amgen, 2, 6, Janssen, 2, 6, 12, Support for conference participation, Novartis, 2, 2, 5, 6, 6, Pfizer, 2, 6, UCB, 2, 6, 12, Support for conference participation; Z. Rotar: None; K. Perdan-Pikmajer: None; M. Bernardes: AbbVie/Abbott, 1, 2, 6, AstraZeneca, 1, 2, 6, GlaxoSmithKlein(GSK), 2, Janssen, 1, 2, 6, Pfizer, 2; B. Gudbjornsson: None; G. Gröndal: None; I. van der Horst-Bruinsma: AbbVie, 2, 5, 12, Fees received for lectures, BMS, 12, Fees received for lectures, Eli Lilly, 2, MSD, 2, 5, 12, Fees received for lectures, Novartis, 2, Pfizer, 5, 12, Fees received for lectures, UCB Pharma, 2, 5; K. Laas: AbbVie/Abbott, 6, Janssen, 6, Novartis, 6; B. Michelsen: Novartis, 5, 6; C. Codreanu: AbbVie/Abbott, 2, 6, Amgen, 2, 6, Boehringer-Ingelheim, 2, 6, Eli Lilly, 2, 6, Ewopharma, 2, 6, Novartis, 2, 6, Pfizer, 2, 6, Sandoz, 2, 6; D. DiGuiseppe: None; B. Moeller: Amgen, 5, Eli Lilly, 6, Janssen, 6, Novartis, 6, 6, Pfizer, 6; G. Kenar: None; M. Hetland: AbbVie/Abbott, 5, 12, Paid to my institution, no personal fee, Bristol-Myers Squibb(BMS), 5, 12, Paid to my institution, no personal fee, Eli Lilly, 5, 12, Paid to my institution, no personal fee, Medac, 6, 12, Paid to my institution, no personal fee, Merck/MSD, 5, 12, Paid to my institution, no personal fee, Novartis, 5, 6, Pfizer, 5, 6, 12, Paid to my institution, no personal fee, Sandoz, 5, 6, 12, Paid to my institution, no personal fee, UCB, 6, 12, Paid to my institution, no personal fee; L. Oernbjerg: Novartis, 5, UCB, 5.

To cite this abstract in AMA style:

Ahmadzay Z, Georgiadis S, Ostergaard M, Glintborg B, Møller-Bisgaard S, Pons M, Heberg J, Christiansen S, Rasmussen S, Loft A, Castrejon I, Otero-Varela L, Závada J, Pavelka K, Rutanen J, Kuusalo L, Nissen M, Rotar Z, Perdan-Pikmajer K, Bernardes M, Gudbjornsson B, Gröndal G, van der Horst-Bruinsma I, Laas K, Michelsen B, Codreanu C, DiGuiseppe D, Moeller B, Kenar G, Hetland M, Oernbjerg L. Do Smoking and Obesity Impact Secukinumab Treatment Outcomes? Real-world Data from 1,202 European Patients with Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/do-smoking-and-obesity-impact-secukinumab-treatment-outcomes-real-world-data-from-1202-european-patients-with-psoriatic-arthritis/. Accessed .

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