190 Real-world experience of secukinumab for psoriatic arthritis and axial spondyloarthritis

Abstract

Background: Secukinumab is the first IL-17 inhibitor licensed for use in psoriatic arthritis (PsA) and ankylosing spondylitis (AS). We wished to characterise patients receiving secukinumab and evaluate the safety and effectiveness in a real-world clinical setting. Method(s): The medical records of NHS patients who have received secukinumab from the rheumatology department in Glasgow were retrospectively reviewed by members of the clinical team. Result(s): 188 patients were identified who were prescribed secukinumab via the Rheumatology department for PsA or AS (patients with PsA receiving this primarily for psoriasis via dermatology were excluded). 139 were prescribed secukinumab for PsA, of which 5 initially started as part of clinical trial (excluded from analysis) and 49 for axial spondyloarthritis (axSpA). The majority of patients had received a previous biologic (PsA 80.6%; AS 67.3%) prior to secukinumab. The starting dose of secukinumab was 150mg for 92% of the AS patients but only 27% of the PsA patients, with the remainder receiving the 300mg dose. 43.3% of PsA patients received a concurrent DMARD (usually methotrexate) with secukinumab. A significant number of patients (14 AS and 32 PsA) had only started secukinumab within the past 3-4 months, so had not yet had their first response assessment (will be available and included in final data). Of the 100 PsA patients with initial follow-up assessment data (average 4.6 months), 76% continued with secukinumab, with 5 increasing dose from 150mg to 300mg. The reasons for stopping treatment in PsA (n=24) were inadequate response (14), adverse events (7) and nonattendance/ delivery issues (3). One patient with PsA stopped as they developed an indeterminate colitis, possibly NSAID-related or Crohn's. The average tender and swollen joint counts changed from 19.2 and 10.7 at baseline to 11.2 and 4.3 at follow-up, respectively. Of the AS patients with initial follow-up assessment (average 5 months), 50% (17/34) stopped secukinumab at this assessment, due to inadequate response (9), adverse events (7) and incidental prostate carcinoma (1). One patient stopped due to worsening inflammatory bowel disease and bowel ischaemia, although the patient felt the worsening preceded starting secukinumab. One other patient stopped due to diarrhoea and low mood but was not investigated further as symptoms resolved on stopping. Overall, the average BASDAI changed from 7.3 at baseline to 5.3 at follow-up. There was minimal change in average ESR or CRP in the PsA group, while in the AS group the CRP reduced from 19.5 at baseline to 10.7 at follow-up. Conclusion(s): Patients in Glasgow with PsA and AS starting secukinumab in clinical practice generally have severe disease and prior biologic exposure. While most PsA patients continued secukinumab, only 50% of patients with AS continued after the first assessment. Two patients developed new or worsening colitis.