Secukinumab provides sustained improvements in signs and symptoms of ankylosing spondylitis
Spondyloarthritis is an umbrella term for several conditions that share many of the same features and symptoms, including ankylosing spondylitis, psoriatic arthritis and reactive arthritis. Patients can also be classified as having axial or non-axial (peripheral) disease, according to which joints in their body are affected. Ankylosing spondylitis (often shortened to AS) mainly affects the axial skeleton and the sacroiliac joints (in the back part of the pelvis), causing back pain and stiffness.
Secukinumab (brand name COSENTYX) is a new drug for ankylosing spondylitis. Secukinumab is a type of biologic medicine (also called a biologic disease-modifying antirheumatic drug, or bDMARD). It works by
blocking interleukin-17A – a molecule involved in the development of inflammation.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to see whether secukinumab would work in people with ankylosing spondylitis who had
been treated before with another type of biologic medicine called an anti-TNF, which blocks a different molecule involved in inflammation. They also hoped to work out whether there was a difference in the response depending on previous treatment.
WHO WAS STUDIED?
The study included 219 people with ankylosing spondylitis. Everyone included was over the age of 18 and had been diagnosed with ankylosing spondylitis. People who had been treated with an anti-TNF biologic medicine before could take part if they had not had a good response despite taking the medicine properly for 3 months or more, or if they had side effects from it.
HOW WAS THE STUDY CONDUCTED?
MEASURE 2 was a double-blind, randomised clinical trial, which means that patients were assigned by chance to one of three treatment groups to receive either secukinumab at a low or high dose, or a placebo (dummy drug). Using chance in this way means that the groups will be similar and will allow the variable or treatment under investigation to be compared objectively. During the treatment neither the patients nor their doctors knew which group they were in.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
People who had taken an anti-TNF biologic medicine before had a significantly better response to the high dose of secukinumab compared to people receiving placebo, with twice as many people seeing improvements in their disease after 16 weeks. People who had not received any kind of biologic medicine before did better than those who had. These effects lasted over the 52 weeks of the study.
ARE THESE FINDINGS NEW?
Yes, this is the first time that secukinumab has been investigated and reported in this way in people with ankylosing spondylitis.
WHAT ARE THE LIMITATIONS OF THE STUDY?
Investigating the effects of previous biologic therapy was a sub-analysis of the MEASURE 2 study, and is not the reason the study was set up. Another limitation is that people who had failed on more than one biologic medicine before were not included. Additionally, the trial included only people with ankylosing spondylitis, not people with an earlier form of their disease called non-radiographic axial spondyloarthritis. This means that the results may not apply to other groups of people.
WHAT DO THE AUTHORS PLAN ON DOING WITH THIS INFORMATION?
This information helps doctors to decide whether to choose secukinimab as the first or second biologic medicine for people with ankylosing spondylitis. More studies are ongoing in patients with non-radiographic axial spondyloarthritis to see whether the results in that group will be the same.
WHAT DOES THIS MEAN FOR ME?
Traditionally, treatments for people with ankylosing spondylitis have been limited. Secukinumab is a new treatment option for people with ankylosing spondylitis, and can be used even if you have taken another biologic medicine before that has not worked for you.
If you would like to find out more about what treatments are available for your particular form of the disease, you should speak to your doctor.
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Date prepared: March 2017
Summary based on research article published on: 31 August 2016
From: Sieper, J. et al. Secukinumab efficacy in anti-TNF-naive and anti-TNF-experienced subjects with active ankylosing spondylitis: results from the MEASURE 2 Study. Ann Rheum Dis 2017;76:571-575. doi:10.1136/annrheumdis-2016-210023.
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