A notable percentage of patients with rheumatic diseases, such as psoriatic arthritis, stop taking bDMARDs due to lack of effectiveness and adverse events.
Patients with psoriatic arthritis (PsA) receiving secukinumab had improvement in disease activity after 1 year of treatment, which was maintained or increased at years 2 and 3, according to a study published in Springer.1
“Rheumatic diseases are extensively managed with biological disease-modifying antirheumatic drugs (bDMARDs), but a notable proportion of patients withdraw in the long term because of lack of effectiveness, adverse events, or the patient’s decision,” investigators explained.
Information was obtained from the prospective Spanish BIOBADASER registry, established in 1999 to assess the long-term safety of bDMARDs, and focused on patients with PsA and axial spondyloarthritis (axSpA, both ankylosing spondylitis [AS] and non-radiographic axSpA [nr-axSpA]) receiving secukinumab for more that 1 year. Retention rates were evaluated based on the percentage of patients who remained on treatment.
Outcome variables for patients with PsA included the mean Disease Activity Score 28 using C-reactive protein (DAS28-CRP), patients achieving remission (DAS28-CRP < 2.6), and those with low disease activity (DAS28-CRP ≥ 2.6; ≤ 3.2). The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) determined remission (BASDAI score < 2) or low disease activity (BASDAI < 4) for patients with axSpA.
Other measurements included swollen joint counts (SJC), tender joint counts (TJC), and the mean Disease Activity Psoriatic Arthritis (DAPSA) scores for patients with PsA. The mean Ankylosing Spondylitis Disease Activity Score (ASDAS) was used for patients in the axSpA group.
In total, 639 patients were analyzed, of which 350 patients were diagnosed with PsA, 262 patients had AS, and 27 patients had nr-axSpA. After 1 year of treatment, patients with PsA receiving secukinumab had improvements in DAS28-CRP (3.0 at baseline; 2.0 at 1 year), SJC (5.8 at baseline; 1.3 at year 3), and TJC (2.7 at baseline; 1.2 at year 3). Patients in the axSpA cohort also had decreases in BASDAI and ASDAS scores. Improvements were either maintained or increased at months 24 and 36.
Retention rates for patients with PsA were 74.1%, 59.1%, and 54.2% at year 1, 2, and 3, respectively. While rates were higher when secukinumab was the first-line biological treatment, they were also satisfactory when used as both second and third lines of treatment.
The majority of patients who discontinued treatment cited lack of effectiveness (67.9%) and adverse events (48 cases, 16.4%). The most common AEs were infections and infestations (27.5%), gastrointestinal disorders (17.7%), and local injection site reactions (5.5%).
The study was limited by the lack of a control group, missing medical history information, and selection bias. Additionally, certain variables, such as DAPSA, were not available for all patients. However, the study focused on the treatment of patients with PsA, AS, and nr-axSpA receiving secukinumab in a real-world setting and is a representative sample of everyday clinical practice in Spain.
“Results of this analysis showed an improvement in disease activity at the first year, which increased at the second and third years of treatment,” investigators concluded. “Overall, these data provide information to be considered by clinicians regarding the use of secukinumab as both the first and subsequent lines.”
Moreno-Ramos, M., Sanchez-Piedra, C., Martínez-González, O., Rodríguez-Lozano, C., Pérez-Garcia, C., Freire, M., Campos, C., Cáliz-Caliz, R., Calvo, J., Blanco-Madrigal, J., Pérez-Gómez, A., Moreno-Martínez, M., Linares, L., Sánchez-Alonso, F., Sastré, C. and Castrejón, I. Springer. 2022. Real-World Effectiveness and Treatment Retention of Secukinumab in Patients with Psoriatic Arthritis and Axial Spondyloarthritis: A Descriptive Observational Analysis of the Spanish BIOBADASER Registry.