Background/Purpose: Until recently, inhibitors of TNF (TNFi) had been the only bDMARD treatment option for patients with axial spondyloarthritis (AxSpA). This situation changed when anti-interleukin-17A monoclonal antibody secukinumab (SEC) became available in March 2017. We aimed to characterize and compare patient populations starting treatment with SEC versus TNFi during the first year of SEC availability in Czech Republic.

Methods: All adult patients with AxSpA who either started biological therapy or switched to a new drug during the period of March 1^st 2017 and March 1^st 2018 were considered. Baseline characteristics of patients were described and compared between the two treatments. Mean ± SD and absolute/relative frequencies were used to describe continuous and categorical variables, respectively. P-value of Fisher‘s exact test and Mann-Whitney test is given when assessing difference between groups in categorical and continuous variables. Odds for the prescription of SEC versus TNFi were assessed using logistic regression. ATTRA is a computerized registry of patients receiving bDMARD therapy in the Czech Republic. Both TNFi and SEC is indicated for patients with AxSpA who have failed treatment with NSAIDs, have CRP ≥ 1mg/dl and BASDAI score ≥ 4. The choice of drug is left to the discretion of treating rheumatologist.

Results: A total of 500 bDMARD treatments were initiated or changed during the study period, 460 were included in the analysis (77 SEC, 383 TNFi). SEC was initiated as first line therapy in 48.1%, TNFi in 49.9.% (P=0.804). Significant differences between SEC and TNFi were observed for some baseline patient characteristics (Table 1). Overall, patients starting SEC tended to have higher disease activity and worse measures of physical functioning. Patients after failure of ≥3 bDMARDs are 4.2 times more likely to receive SEC compared to patients starting their first line bDMARD (P <0.001). Odds of receiving SEC increase with increasing values of CRP (P = 0.027), BASDAI (P = 0.004), ASDAS (P = 0.024), BASFI (P = 0.004) and decrease with higher scores of SF36 physical role functioning (P = 0.008), physical functioning (P = 0.004) and bodily pain (P = 0.005) domains. Baseline disease activity and physical functioning measures were not significantly different between SEC and TNFi among a subgroup of 228 patients (37 SEC, 191 TNFi) receiving first line bDMARD.

Conclusion: Our data suggest that in real-life SEC is used as a first line bDMARD just as often as TNFi, however after failure of at least three bDMARDs patients are more likely to receive SEC. Overall patients starting SEC tend to have higher disease activity compared to patients starting TNFi.

Table 1: Selected baseline characteristics of patients starting SEC or TNFi treatment for AxSpA

This study was supported by the project of MHCR for conceptual development of research organization 00023728

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-use-of-secukinumab-in-axial-spondyloarthritis-first-year-data-from-the-czech-national-registry/