SECUKINUMAB - AN OVERACHIEVER IN REAL-LIFE CLINICAL SETTING -	HOW TO INTERPRET REAL WORLD EVIDENCE OF SECUKINUMAB IN SPONDYLOARTHRITIS

Claudia Cobilinschi; Cristian Cobilinschi; Daniela Opris-Belinski; Ruxandra Ionescu; Andra Bălănescu

doi:10.33695/rjcr.v4i2.79

Claudia Cobilinschi Sf. Maria Clinical Hospital – Rheumatology and Internal Medicine Department, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Cristian Cobilinschi Carol Davila University of Medicine and Pharmacy, Bucharest, Romania & Bucharest Clinical Emergency Hospital, Intensive Care Unit, Romania
Daniela Opris-Belinski Sf. Maria Clinical Hospital – Rheumatology and Internal Medicine Department, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Ruxandra Ionescu Sf. Maria Clinical Hospital – Rheumatology and Internal Medicine Department, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Andra Bălănescu Sf. Maria Clinical Hospital – Rheumatology and Internal Medicine Department, Bucharest, Romania & Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

DOI: https://doi.org/10.33695/rjcr.v4i2.79

Keywords: spondyloarthritis, psoriatic arthritis, secukinumab, anti-IL17, enthesitis, uveitis, cancer

Abstract

The treat to target approach aims to attain remission or minimal disease activity in pacients with spondyloarthritis (SpA) or psoriatic arthritis (PsA). Secukinumab(SEK), an IL-17A inhibitor is of high use in anti-TNF fails or as first-line therapy when skin involvement is dominant. Primary outcome of the study was to evaluate response to SEK in bDMARD naïve and non-naïve AS and PsA patients in a real-world cohort. Secondary outcomes were SEK mean retention rate, adverse events occurance. A single-center observational, retrospective study was performed in AS and PsA patients started or switched on SEK, with a minimum follow-up period of six months. Outcome measures (BASDAI, ASDAS, inflammatory markers) were recorded at baseline and at the last follow-up visit. Statistical analysis used SPSS 20.0. Forty patients were included in the study, two discontinued treatment. Out of the 38 remaining patients, 9 had PsA and 29 SpA, mean age 54.6 and 49.75 respectively, with a slight male predominance (57.8% versus 42.1%). Mean disease duration was 108.4 months. 14 patients were started directly on SEK 150mg, while 24 were switched from a previous anti-TNF, ranging from one to five agents (12 non-responders, 12 adverse reactions). Pacients with PsA required a more frequent switch on SEK than patients with SpA. A drastic decrease in BASDAI score was observed in patients after they were started on SEK, from a mean value of 6.38 to 1.78, indicating an inactive disease at follow-up (p<0.0001). ASDAS-CRP decreased from a mean 4.12 to 1.67, classifying patients as having inactive to moderate disease (p<0.0001).In the PsA group the DAPSA score decreased with a mean of 26.1 points (p<0.0001) from 35.2 to 9.1 (p<0.0001).Likewise, C-reactive protein significantly decreased with a mean of 26 mg/dl at follow-up.

While there was no significant difference in BASDAI, the ASDAS-CRP mean difference confirmed benefit in patients who were first started on SEK compared to those with previous bDMARDs (-3.12 vs -2.21) p=0.08. Mean retention rate for SpA patients was 23.5 months, while for PsA patients it was 16.2 months (p=0.019). SEK survival rate was higher in patients with prior anti-TNF alpha therapy when compared to naïve-patients, with a value of 23.3 months versus 18.9, p 0.034.There was no difference in SEK drug survival as monotherapy versus combination with csDMARD (p 0.28). SEK was effective in lowering disease activity as proven by a reduction in clinical parameters and inflammatory markers showing prompt effect of the anti-IL17 agent.

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