Secukinumab treatment of axial spondyloarthritis in real world: Achievement of fast response results in effective treatment outcomes

Background: Individualized treatment strategies are of high importance in the treatment of patients with chronic immune-mediated diseases such as axial sponyloarthritis (axSpA) IL17 inhibition has demonstrated good efficacy on all manifestations of axSpA but in some patients a lack of efficacy can be observed. To analyze patient characteristics leading to treatment response pattern in axSpA patients, data from the German non-interventional study “AQUILA” (Kiltz et al. 2019) was analyzed. Methods: “AQUILA” includes, in addition to patients with psoriatic arthritis, patients with active axSpA. In the current analysis, patients started treatment within a period of 4 weeks around their baseline visit (V1), and were followed-up over up to 52 weeks (V2-V6). Response in this cohort was defined as a combination of patient- (BASDAI) and physician-derived (PhGA) assessments. Patients who reached a state of remission (BASDAI ≤ 3 and PhGA ≤ 1) or adequate improvement (20% improvement in BASDAI and PhGA compared to baseline) at any time during the study period were considered responders. A fast response was defined as reaching at least adequate improvement within the first 8 weeks of treatment (V2), all other responses were considered as late responses. Results: A cohort of 358 axSpA patients was analyzed and divided into 3 subgroups (Table 1). Fast response was significantly associated with biological naivety (p=0.04) and stronger therapy effect during the further course of treatment with higher rates of 50% response (p=0.007) and remission state (p=0.03). Conclusion: Our results show that secukinumab is an effective biologic treatment in axSpA patients. As with every available treatment option, its response is dependent on demographics and disease characteristics. The results underline the dependency of fast response on clinical phenotype. Fast responders seem to benefit from both fast alleviation of symptoms and effective treatment outcomes.