E097 The efficacy and tolerability of secukinumab in psoriatic arthritis and ankylosing spondylitis in NHS Tayside

Abstract

Background: Secukinumab is a novel biologic that has recently been introduced into NHS Tayside for the treatment of psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis (AS). It is a fully humanized monoclonal antibody directed against the A ligand of interleukin 17 (IL- 17A). PsA is the rheumatological manifestation of the dermatological condition psoriasis, involving scaling, erythema and breakdown of the skin. AS is characterised by inflammation and osteogenesis of the axial spine, presenting as sacroiliitis and spondylitis. IL-17A has been implicated in the pathogenesis of both AS and PsA. This audit investigated the efficacy and tolerability of secukinumab in patients within NHS Tayside suffering from PsA and AS. Methods: A paired T-test was used to compare disease indices. This was the number of swollen and tender joints for PsA and the Bath ankylosing spondylitis disease activity index (BASDAI). Results were always compared to the last previous set of disease indices prior to commencing secukinumab. A 2-way MANOVA test was used to gauge the effect of the other clinical parameters on disease activity in both diseases prior to and after secukinumab therapy. Results: There were 36 patients with PsA in NHS Tayside prescribed secukinumab. In PsA, swollen joints significantly decreased at 3 months (t (28) =6.59, p<0.0001) from 6.1 to 1.8 (70.5% decrease) and 6 months (t (22) =4.01, p=0.001) from an average of 5.4 to 1.0 (81.6% decrease). Tender joints also significantly decreased at 3 months (t (22) =2.58, p=0.015) from 9.1 joints to 3.2 (65.1% decrease) and 6 months (t (22) =2.58, p=0.015) from an average of 9.1 joints to 3.2 (65.1% decrease). 4 patients out of 36 (11.11%) experienced side effects, 3 of which were sicca symptoms and 1 of which was a likely upper respiratory tract infection. In AS, 13 patients with documented AS were prescribed secukinumab. There was a significant decrease in the total BASDAI score at 3 months (t (7) =2.84, p=0.025) from 7.2 before to 4.3 after (41% decrease) and at 6 months (t (9) =5.01, p=0.001) from 6.8 to 3.4 after (49.7% decrease). 1 patient (7.7%) experienced side effects of fluid filled blisters in their mouth. Women fared significantly better than men in both PsA and AS. There was no significant effect of DMARD usage or dose (in PsA) on outcome. Younger patients did significantly better than older patients in both conditions. The majority of patients in both conditions were not prescribed concurrent antibiotics, NSAIDs or COX-2 inhibitors whilst on secukinumab. Conclusion: These data validate the use of secukinumab in NHS Tayside with a great majority of patients seeing improvements in their disease activity indices. It will be interesting to observe how these patients fair further on in their treatment.