Drug retention, inactive disease and response rates in 1860 patients with axial spondyloarthritis initiating secukinumab treatment: routine care data from 13 registries in the EuroSpA collaboration

Abstract

Objectives: To explore 6-month and 12-month secukinumab effectiveness in patients with axial spondyloarthritis (axSpA) overall, as well as across (1) number of previous biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs), (2) time since diagnosis and (3) different European registries.

Methods: Real-life data from 13 European registries participating in the European Spondyloarthritis Research Collaboration Network were pooled. Kaplan-Meier with log-rank test, Cox regression, χ² and logistic regression analyses were performed to assess 6-month and 12-month secukinumab retention, inactive disease/low-disease-activity states (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <2/<4, Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3/<2.1) and response rates (BASDAI50, Assessment of Spondyloarthritis International Society (ASAS) 20/40, ASDAS clinically important improvement (ASDAS-CII) and ASDAS major improvement (ASDAS-MI)).

Results: We included 1860 patients initiating secukinumab as part of routine care. Overall 6-month/12-month secukinumab retention rates were 82%/72%, with significant (p<0.001) differences between the registries (6-month: 70-93%, 12-month: 53-86%) and across number of previous b/tsDMARDs (b/tsDMARD-naïve: 90%/73%, 1 prior b/tsDMARD: 83%/73%, ≥2 prior b/tsDMARDs: 78%/66%). Overall 6-month/12-month BASDAI<4 were observed in 51%/51%, ASDAS<1.3 in 9%/11%, BASDAI50 in 53%/47%, ASAS40 in 28%/22%, ASDAS-CII in 49%/46% and ASDAS-MI in 25%/26% of the patients. All rates differed significantly across number of previous b/tsDMARDs, were numerically higher for b/tsDMARD-naïve patients and varied significantly across registries. Overall, time since diagnosis was not associated with secukinumab effectiveness.

Conclusions: In this study of 1860 patients from 13 European countries, we present the first comprehensive real-life data on effectiveness of secukinumab in patients with axSpA. Overall, secukinumab retention rates after 6 and 12 months of treatment were high. Secukinumab effectiveness was consistently better for bionaïve patients, independent of time since diagnosis and differed across the European countries.

Keywords: DMARDs (biologic); Outcomes research; Spondyloarthritis.

Figure 1

Pooled 12-month secukinumab retention rates for patients with axial spondyloarthritis in the European Spondyloarthritis Research Collaboration Network stratified by previous biologic/targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment (log-rank test; p<0.001).

Figure 2

Secukinumab retention rates due to adverse events (AE) and loss of efficacy (LOE, Kaplan-Meier plot; for 29 patients, it was not distinguished by the registries whether reason for withdrawal was due to AE or LOE).

Figure 3

Twelve-month secukinumab retention rates compared across patients with axial spondyloarthritis in different European registries (Kaplan-Meier with log-rank test; ICEBIO (Iceland) and 12-month number at risk for TURKBIO (Turkey) are excluded from the plot due to <10 patients).

Figure 4

Bar charts of proportions of patients achieving different disease state and response rates after 6 and 12 months of secukinumab treatment compared across previous biologic/targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) treatment. ASAS20/40, Assessment of Spondyloarthritis International Society 20/40 response; ASDAS CII, ASDAS clinically important improvement (≥1.1); ASDAS MI, ASDAS major improvement (≥2.0); BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASDAI50, 50% improvement in BASDAI.