Secukinumab in axial spondyloarthritis: a narrative review of clinical evidence

Abstract

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease characterized by inflammation and new bone formation in the axial skeleton. AxSpA is considered a spectrum of disease that includes two subtypes identified by the Assessment in SpondyloArthritis International Society classification criteria, namely, radiographic (r-axSpA usually referred to as ankylosing spondylitis) and non-radiographic axSpA (nr-axSpA). Although the burden of disease appears similar between the two classified subtypes, the degree of inflammation, as assessed by magnetic resonance imaging and C-reactive protein, and the degree of new bone formation are significantly higher in r-axSpA than in nr-axSpA. Nevertheless, axSpA is considered one disease with different courses. International guidelines for the management of axSpA have outlined treatment goals focused on control of signs and symptoms, inflammation, prevention of progressive structural damage, preservation of physical function, normalization of social participation and improvement of quality of life. The pathogenesis of axSpA has not been completely elucidated to date. A strong link between human leukocyte antigen B27 and axSpA, however, has been identified, and the success of anti-tumour necrosis factor and anti-interleukin (IL)-17A therapy has highlighted some of the key pro-inflammatory cytokines involved. The anti-IL-17A monoclonal antibody secukinumab is approved for the treatment of ankylosing spondylitis and nr-axSpA in the European Union and United States. In this narrative review, we discuss data for secukinumab in axSpA from randomized controlled trials, including MEASURE trials in AS and PREVENT in nr-axSpA, and real-world evidence.

Effectiveness and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a 52-week real-life study in an Italian cohort

“…Interleukin (IL)-17 is a key player in the pathogenesis of SpA [13][14][15][16] and a new class of biologics blocking IL-17 has been developed and approved for treatment as an alternative to TNFi [17,18]. In clinical trials, secukinumab, a fully human anti-IL17A IgG1/κ monoclonal antibody, has in fact shown good efficacy and safety in both AS and PsA [17,18].…”

Therapeutic Targets for Ankylosing Spondylitis – Recent Insights and Future Prospects

“…26 Finally, post-hoc analysis of randomized trials confirmed the efficacy of secukinumab in AS patients over different domains including pain, fatigue, spinal stiffness, articular function, laboratory serum markers of inflammation, work productivity and health-related quality of life (reviewed in). 27 …”

Comparison of drug survival for Recurrent switching between IL-17 inhibitors and TNF- inhibitors in patients with axial spondyloarthritis

“…[6] All these data obtained from RCT are useful in treatment decision making, but strict inclusion and exclusion criteria mean that trial populations may not be truly representative of patient populations in clinical practice. [3] Drug survival is a composite measure of effectiveness and safety. [6] With this in mind, we conducted a longitudinal observational retrospective study to ascertain survival rates of TNF-i & IL17-i therapies, as well as the reasons and potential predictors for drug discontinuation and switching between both groups in axSpA patients under routine clinical care.…”

“…Thus, switching TNF-i therapy has become a common clinical practice and highlighted the need for new therapies with alternative mechanisms of action. [3] With more understanding of the pathophysiology of SpA & the introduction of IL-17 inhibitors (IL17-i) therapy, the management of such patients has witnessed a huge step forward. Interleukin (IL)-17A, a mediator in in ammatory pathways, has been identi ed as a key cytokine in the pathogenesis of axSpA.…”

“…This has led to the development of IL-17A inhibitors for the treatment of axSpA. [3] Data from randomized controlled clinical trials and post-marketing surveillance have shown this line of therapy to have a favourable safety pro le over long-term treatment, even with fewer adverse events and low frequency of treatment discontinuation.…”