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Background: Secukinumab was approved by NICE for patients with active Ankylosing Spondylitis and Psoriatic Arthritis in 2017. Clinical trial data suggests secukinumab is a useful treatment option in both conditions, but often real world experience differs greatly from clinical trial results. In addition, patients with more refractory disease are often excluded from clinical trials.
Objectives: To assess the response to secukinumab in patients with seronegative spondyloarthropathy receiving treatment at University Hospital Coventry and Warwickshire
Methods: Patients starting secukinumab at UHCW were identified from the Blueteq funding database. Medical notes were reviewed retrospectively to assess response rates using BASDAI responses in Ankylosing spondylitis and PsARC responses in PsA. Patients who had previously had inadequate response to TNF inhibitors (PsA only) and severe psoriasis received 300mg secukinumab monthly; the remainder were prescribed 150mg monthly.
Results: 146 patients commenced secukinumab between June 2017 and January 2020 and had outcome data recorded. 73 patients (50%) had received previous biologic agents prior to secukinumab exposure. Patients with Ankylosing spondylitis had high BASDAI (6.8±1.4) and spinal pain (7.5±1.4). 48 patients had an initial response to treatment as per outcome measures done before and after Secukinumab inception. Secukinumab was effective in 89 patients (94%), and 87 (91%) continued treatment.
In psoriatic arthritis, despite high levels of activity at baseline (mean tender joint count 10±8; swollen joint count 6±3) and 65% prior biologic exposure; high rates of response were seen. The majority of patients have continued treatment. Secukinumab was well tolerated in both patient groups with low rates of discontinuation due to adverse events (8 patients, 5%). Adverse events included recurrent infection (3), rash (1), mouth ulcers (1), vertigo (1), new onset cancer (1) and new onset Crohn’s (1) although rates were low overall. Patients with pre-existing uveitis did not develop exacerbations but low numbers of patients with prior uveitis were treated.
| PsA (n=51) | AS (n=95) | |
|---|---|---|
| Age in years, mean (SD) | 53 (13) | 49(12) |
| Male sex, n (%) | 21 (41) | 62 (65) |
| Disease duration in years, mean (SD) | 8 (8) | 10.9 (9.2) |
| Previous biologic exposure, n (%) | 30 (65) | 43 (48) |
| Number of prior biologics, median (range ) | 1 (1-4) | 1 (1-4) |
| Responder, n (%) | 37 (72)* | 89 (93) |
| Discontinuation, n(%) | 12 (24) | 8 (8.5) |
| Adverse events | 6 | 2 |
| Lack of efficacy | 6 | 4 |
| Other | 0 | 2 |
*Response could not be assessed in 3/51 PsA patients due to insufficient clinical data; these patients have been recorded as non responders
Conclusion: Secukinumab demonstrates high levels of efficacy even in a cohort of patients with longstanding PSA and AS with high rates of inadequate responses to other biologics.
Secukinumab is well tolerated with low rates of discontinuation due to adverse events.
REFERENCES:
Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs Technology appraisal guidance [TA445]
Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors Technology appraisal guidance [TA407]
Disclosure of Interests: None declared