Secukinumab alternatives suggested for ankylosing spondylitis patients with pre-existing IBD
medwireNews: Researchers report that secukinumab is associated with an increased risk for gastrointestinal-related adverse events (GIRAEs) in patients with ankylosing spondylitis (AS) and pre-existing inflammatory bowel disease (IBD) and say that prescribing alternatives should be considered.
“It seems prudent for clinicians to consider alternative immune modulatory strategies for patients with pre-existing IBD, especially in the context of AS,” write the researchers in Rheumatology.
By contrast, they say that rates of GIRAE associated with the interleukin (IL)-17A inhibitor are low in AS patients without pre-existing IBD and in those with psoriatic arthritis (PsA).
They analyzed data for 306 patients with AS (40.5%) or PsA (59.5%), who had received at least one dose of secukinumab between 2016 and 2019. Seven (2.3%) of the patients – six with AS – had pre-existing IBD before taking secukinumab.
In total, 24 patients had a GIRAE, the majority (63.0%) of whom were AS patients, and most (87.5%) events occurred within the first year of treatment.
Researcher Ioana Onac (King’s College London, UK) and co-authors note that “[t]he majority of patients developing a new GIRAE did not develop objective evidence of IBD or stop therapy.”
Indeed, only four patients (1.3% of the whole cohort) with a GIRAE had biopsy-proven IBD, with a clear temporal association, resolution of symptoms upon drug withdrawal, and for which no alternative explanation was likely, and stopped taking secukinumab. All four of the patients had AS, two had pre-existing IBD, and two had de novo IBD, one of whom needed surgical intervention.
Seven patients with a GIRAE had probable IBD, with the same symptoms as the definitive cases but without a biopsy confirmation, and secukinumab was interrupted in six of these patients. The remaining 13 patients with a GIRAE had possible IBD, two of whom discontinued secukinumab. In both cases around half of the patients had AS.
Further analyses revealed that patients with a prior IBD diagnosis and those with AS rather than PsA had a significant 14.1-fold and 2.8-fold increased risk for GIRAEs, respectively.
Overall, the researchers say that “[t]he absolute rates of new [IBD] in patients starting secukinumab are low,” and that “IBD screening prior to starting anti-IL-17 is not supported particularly in PsA patients.”
But they caution: “For patients with pre-existing IBD and AS the risk for GIRAE is much higher, and prescribing alternatives should be considered.”
Onac et al conclude that “[f]urther research to evaluate the characteristics of AS patients with no history of IBD should be considered in view of stratifying IBD risk prior to IL-17 inhibition.”
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