Background/Purpose: Secukinumab is a newly introduced biologic therapy against IL-17 which has been proved effective in patients with ankylosing spondylitis (AS)  in clinical trials and it has been added to the most recent national and international treatment guidelines. However, real-world data of its use is still scarce.
This study aims to analyze drug survival of secukinumab for axial spondyloarthritis (AxSpA) in a real world setting and identify response factors.

Methods: Multicentric observational, retrospective, longitudinal study conducted in 4 tertiary hospitals of the Madrid region. Patients over 18 y.o. with clinical diagnosis of AxSpa and having received at least one dose of secukinumab between January 2016 and October 2018 were included. Medical records were reviewed to collect demographic and clinical data related to AxSpA, its features and treatment. Statistical analysis was performed including bivariate analisys (considering withdrawal of drug during study period or not) and  survival analysis with Kaplan-Meier and Cox regression. Reasons for discontinuating therapy were described.  To detect inffluential variables, demographic characteristics, HLA-B27 positivity, radiographic features, previous biologic therapies, comorbidities and extra-articular involvement were analyzed.

Results: Out of 143 patients included, 89 (62% ) mantained secukinumab therapy at the end of the observation period (Dec 31, 2018), with an average drug survival time of 17 ± 8,2 months. 54 patients (38%) withdrawn therapy, due to primary ineffectiveness (26) , secundary ineffectiveness (14), adverse events (7) and other reasons (7). Median time to withdrawal was 6 months (0-21). No significative differences were found between groups, but a tendency to higher number of female patients (55% vs 41%, p 0,07), non radiographic AxSpA  (35% vs 27%, p 0,053) and lower  HLA-B27 positivity  (50% vs 65%, p 0,052) was noted in the group withdrawing therapy. Previous exposure to biologic therapy did not differ (75% vs 71%, p 0,37). Number of bDMARDs before Secukinumab therapy was also similar in both groups; the proportion of patients with previous exposure to 2 or more bDMARDs were 17% vs 22% (p 0.373). Neither differences were found in all other variables studied (demographic, hip arthropathy, syndesmophytes, extra-articular involvement -uveitis, psoriasis, inflammatory bowel disease- nor in comorbidities (tobacco exposure, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, malignancy).

Conclusion: This study assesing drug survival of secukinumab in real-world setting showed a trend to lower drug survival in comparison to clinical trial data. No differences were found in the treatment withdrawal group. Population in which secukinumab is prescribed in real-world setting differs from clinical trials, with higher previous exposure to bDMARDs and higher comorbidity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/drug-survival-of-secukinumab-for-axial-spondyloarthritis-in-a-real-world-setting-possible-response-factors/