Objective To compare effectiveness of treatment with secukinumab (SEC) with that of alternative tumour necrosis factor inhibitors (TNFis) in patients with axial spondyloarthritis (axSpA) after withdrawal from one or more TNFis.
Methods Patients diagnosed as having axSpA in the Swiss Clinical Quality Management cohort were included if they had initiated SEC (n=106) or an alternative TNFi (n=284) after experiencing TNFi failure. Drug retention was investigated with matching weights propensity score (PS) analyses and multiple adjusted Cox proportional hazards models. Matching weights PS-based analyses and multiple-adjusted logistic regression analyses were used to assess the proportion of patients reaching 50% reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50) at 1 year.
Results SEC was more often used as third-line or later-line biological drug (76% vs 40% for TNFi). Patients starting SEC had higher BASDAI, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index and C reactive protein levels. A comparable risk of drug discontinuation was found for SEC versus TNFi (HR 1.14, 95% CI 0.78 to 1.68 in the PS-based analysis and HR 1.16, 95% CI 0.79 to 1.71 in the multiple-adjusted analysis). No significant difference in BASDAI50 responses at 1 year was demonstrated between the two modes of biological drug action, with CI of estimates being, however, wide (OR for SEC vs TNFi 0.76, 95% CI 0.26 to 2.18 and 0.78, 95% CI 0.24 to 2.48 in the PS-based and the covariate-adjusted model, respectively).
Conclusion Our data suggest a comparable effectiveness of SEC versus an alternative TNFi after prior TNFi exposure.
- ankylosing spondylitis
- DMARDs (biologic)
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Handling editor Josef S Smolen
RM and CT contributed equally.
Contributors Study conception and design: RM, CT, AS, AC. Acquisition of data: RM, KB, KN, MJN, PZ, PE, BM, DK, AC. Statistical analysis: CT, AC, AS. All authors contributed to the interpretation of the data. AC wrote the manuscript. All authors critically revised the manuscript. All authors revised and approved the final manuscript to be published.
Funding The SCQM Foundation is supported by the Swiss Society of Rheumatology and by AbbVie, Celgene, iQone, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Sanofi Genzyme and UCB. This study was supported by a research grant from Novartis.
Competing interests AC has received consulting and/or speaking fees from AbbVie, Celgene, Eli Lilly, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Pfizer and UCB. MJN has received consulting and/or speaking fees from Abbvie, Celgene, Eli Lilly, Novartis and Pfizer.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval The study was approved by the ethics committee of the Kanton of Zurich and written informed consent was obtained from all patients.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.