Secukinumab Dose Escalation, Retention Rate, and Safety in Real-World Settings

While secukinumab (SEC) has been proven effective in treating patients with psoriatic arthritis (PsA), it is less clear if patients gain in response if their dose is escalated from 150 mg to 300 mg. A new abstract presented at the European League Against Rheumatism annual meeting analyzed the usefulness of dose escalation in patients with PsA who did not respond to 150 mg in a real-world setting.¹

The analysis included 98 patients with PsA who were treated with SEC in an observational, longitudinal, retrospective study at a tertiary hospital between January 2016 and December 2019. The patients were divided into 3 groups based on the dose they received: SEC150 (n = 58), SEC300 (n = 12), or SEC150-300 (n = 28), which included nonresponders who were increased to 300 mg.

The time from initiation to discontinuation was 1.3 years in the SEC150 group, 1.6 years in the SEC300 group, and 1.6 years in the SEC150-300 group. The average time of dose increase to 300 mg was 9 months. In the 3 groups, there was a significant decrease in C-reactive protein (CRP), Ankylosing Spondylitis Disease Activity Score with CRP, and Disease Activity in Psoriatic Arthritis after 6 months, but there were no significant differences between the 3 dose groups.

“In the case of patients not responding to SEC 150 mg and prior failure to [tumor necrosis factor inhibitor], increasing the dose to 300 mg could be an effective option,” the authors concluded.

A second abstract also evaluated SEC in real clinical practice to treat PsA and spondyloarthritis (SpA) through a retrospective, longitudinal, observational, multicenter study.² The researchers were analyzing retention rate and safety of SEC, as well as causes and factors associated with drug survival (ie, the time from drug initiation to discontinuation).

They included 154 patients (59 with PsA and 95 with SpA). SEC was the first line of treatment in 8% of patients, the second line in 30%, the third line in 35%, and subsequent lines in 27%. The median drug survival time was 23 months. The 1-year retention rate was 66%, and the 2-year retention rate was 43%. Inefficacy was the main reason patients discontinued SEC (59%), followed by adverse events (36%).

Duration of disease, number of previous biologics, male gender, obesity, and depression were the main factors identified as predictors of SEC survival.

References

1. Martin Lopez M, Joven-Ibáñez B, Pablos JL. Impact of dose escalation of secukinumab in patients with psoriatic arthritis in real-world setting. Presented at: EULAR 2020; June 3-6, 2020; Abstract SAT0428. https://ard.bmj.com/content/79/Suppl_1/1168.2

2. Villa-Blanco I, Alonso Castro S, Fernández S, et al. Safety and survival of secukinumab in spondyloarthritis and psoriatic arthritis: real-life data. A multicenter study. Presented at: EULAR 2020; June 3-6, 2020; Abstract FRI0291. https://ard.bmj.com/content/79/Suppl_1/734.2