Secukinumab in AxSpA and PsA: A Drug Survival Analysis

A new retrospective study to be presented at the American College of Rheumatology/Empowering Rheumatology Professionals Annual Meeting assessed drug survival of secukinumab and associated factors in patients with axial spondylarthritis (axSpA) and psoriatic arthritis (PsA).

The observational study included axSpA and PsA patients treated at multiple centers between July 2016 and April 2019 who received at least one secukinumab injection. Collected patient data included demographic and clinical characteristics, onset date, initial dosage and dosage modification of secukinumab, previous biologic disease-modifying antirheumatic drugs (bDMARDs), and concomitant treatments; further analysis was conducted in the axSpA group for radiographic or MRI evidence of sacroiliitis or elevated C-reactive protein (CRP).

Final analysis included 556 total patients (58% [n = 324] were female), of whom 338 (61%) had axSpA and 183 (33%) had PsA. Mean patient age was 47 years. Other identified characteristics included: 221 (40%) were smokers,160 (29%) had radiographic sacroiliitis, 238 (43%) had MRI sacroiliitis, 206 (37%) had elevated CRP, 239 (43%) were HLA B27 positive, and mean Bath Ankylosing Spondylitis Disease Activity Index was 48.9%. A quarter of secukinumab patients were taking methotrexate, and in 10% of patients, secukinumab was the first-line bDMARD.

Median secukinumab survival was 76 weeks; at 52 weeks, 245 (60%) axSpA patients were still receiving secukinumab. Most (n = 172, 68%) patients discontinued secukinumab treatment due to ineffectiveness, while 46 (18%) discontinued due to adverse events and 13 (5.1%) had other reasons. First-line secukinumab patients had longer drug survival (111 weeks) compared to second-line and more patients (69 weeks). Sex, disease, methotrexate, elevated CRP, axSpA vs. PsA, and smoking status did not largely affect drug survival; absence of radiographic or MRI sacroiliitis and normal CRP had no significant impact on survival in the axSpA cohort.

“In routine clinical practice, [secukinumab] median survival was 76 weeks,” the researchers wrote in their abstract. “First-line administration was associated with improved [secukinumab] retention.  Lack of effectiveness was the most common reason of discontinuation.”