Symptom relief and time on therapy are similar for people taking TNF inhibitors or secukinumab after previous TNF inhibitor failure.

INTRODUCTION

Spondyloarthritis (often shortened to SpA) is an umbrella term for several conditions that share many features and symptoms. These conditions include ankylosing spondylitis, psoriatic arthritis and reactive arthritis. Spondyloarthritis can be classified as axial or non-axial (peripheral), according to which joints in the body are affected. Axial disease affects the spine. Peripheral disease affects other joints in the body, such as the hands, shoulders, knees or feet. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to people with axial spondyloarthritis. These drugs help reduce inflammation and pain. If these do not work, then people may be given a type of
medicine called a biologic disease-modifying antirheumatic drug (often shortened to a biologic and sometimes also called a bDMARD). These biologic drugs work by targeting specific molecules that cause inflammation. By doing so, they reduce inflammation in the joints and decrease pain and disease worsening. There are two types of biologic medicine that are used for axial spondyloarthritis. They block either tumour necrosis factor (TNF inhibitors) or interleukin-17 (IL-17 inhibitors). Current international treatment recommendations mention
TNF or IL-17 inhibitors as the first biologic option to try. This also applies to people with axial spondyloarthritis who have already failed a TNF inhibitor.

WHAT DID THE AUTHORS HOPE TO FIND?

The authors wanted to see whether drugs blocking TNF or drugs blocking IL-17 would work better for people
with axial spondyloarthritis who had already tried at least one type of TNF inhibitor.

WHO WAS STUDIED?

The study looked at 390 people with axial spondyloarthritis who had not had a good response from one or more TNF inhibitors, and who had then been switched to either a different TNF inhibitor, or an IL-17 inhibitor called secukinumab. Everyone had been treated in Switzerland and their information had been recorded in a registry database.

HOW WAS THE STUDY CONDUCTED?

This was a retrospective observational study. This means that the authors used an existing database of patient records to look back and find people for each group. There was no interventional treatment given. People were included if they had been treated with at least two TNF inhibitors, or a TNF inhibitor and then secukinumab. How well each treatment worked was analysed both directly and indirectly. The direct results recorded how well each drug relieved people’s symptoms after 1 year. The indirect results looked at how long people continued taking the drug.

WHAT WERE THE MAIN FINDINGS OF THE STUDY?

The main finding was that people who took secukinumab or another TNF inhibitor after failing a previous TNF inhibitor had similar outcomes. Overall, more people who took secukinumab had already failed two or three TNF inhibitors. They also had higher disease activity and greater loss of physical function and mobility. However, how long people kept taking the two different kinds of drugs and how much their symptoms improved was similar.

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Date prepared: August 2020

Summary based on research article published on: 24 June 2020

From: Micheroli R, et al. Effectiveness of secukinumab versus an alternative TNF inhibitor in patients with
axial spondyloarthritis previously exposed to TNF inhibitors in the Swiss Clinical Quality Management Cohort.
Ann Rheum Dis 2020;79:1203–1209. doi: 10.1136/annrheumdis-2019-215934

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