Secukinumab comparable to TNF inhibition in axSpA
medwireNews: Secukinumab shows comparable drug retention and efficacy to tumor necrosis factor (TNF) inhibitors for the treatment of patients with axial spondyloarthritis (axSpA) and prior exposure to TNF inhibitors, observational study findings indicate.
The results are based on data for 106 individuals with axSpA from the Swiss Clinical Quality Management cohort who were treated with the interleukin (IL)-17A inhibitor secukinumab after experiencing TNF inhibitor failure. These patients were matched by propensity scoring to 284 individuals who were instead treated with an alternative TNF inhibitor following prior failure.
Writing in the Annals of the Rheumatic Diseases, Adrian Ciurea (University Hospital Zurich, Switzerland) and co-authors report that the primary outcome of drug retention was not significantly different between the two treatments.
Indeed, during a mean 11.5 months of follow-up, 58.5% and 49.6% of patients stopped secukinumab and TNF inhibitors, respectively. The main reasons for discontinuation were ineffectiveness (58.1 vs 60.3%) and adverse events (27.4 vs 18.4%), with 3.2% and 2.8%, respectively, stopping treatment due to remission.
The researchers note that secukinumab was more likely to be used as third-line or later-line treatment than alternative TNF inhibitors (76 vs 40%), and in line with this, patients starting secukinumab had higher baseline BASDAI, BASFI, and BASMI scores and C-reactive protein levels.
However, after adjustment for potential confounders, there was no significant difference between the two treatment groups in the proportion of patients achieving a 50% reduction in BASDAI or in the proportion improving by at least 2 BASDAI points.
There was also no difference in the percentage achieving an ASDAS below 2.1 or an improvement of least 1.1 ASDAS points.
Ciurea et al therefore conclude that their “longitudinal data from a real-life axSpA cohort suggest that after TNF [inhibitor] exposure, switching to [secukinumab] is comparably effective to switching to another TNF [inhibitor].”
They add: “Head-to-head randomized trials would be particularly useful to confirm these results and to potentially identify specific patient subsets who may particularly benefit from switching to IL-17 inhibition.”
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