study of efficacy and safety of secukinumab in patients with non-radiographic axial spondyloarthritis

Conditions: Non-radiographic Spondyloarthritis

Summary: the purpose of this study was to demonstrate the clinical efficacy, safety and tolerability of secukinumab compared to placebo in patients with nr-axspa at week 16 as well as week 52 and long term efficacy and safety up to week 104 (core phase) followed by an optional extension phase consisting of a 16-week randomized dose escalation treatment period and a continuous treatment period for up to week 208

patients were randomized to one of three treatment groups (1:1:1) in the core phase: * secukinumab 150 mg load: secukinumab 150 mg (1 ml, 150 mg/ml) s.c. pre-filled syringe (pfs) at baseline, weeks 1, 2, and 3, followed by administration every four weeks starting at week 4 * secukinumab 150 mg no load: secukinumab 150 mg (1 ml, 150 mg/ml) s.c. pfs at baseline, placebo at weeks 1, 2, and 3, followed by secukinumab 150 mg pfs administration every four weeks starting at week 4 * placebo: placebo (1 ml) s.c. pfs at baseline, weeks 1, 2, 3, followed by administration every four weeks starting at week 4. all patients received secukinumab 150 mg as open-label treatment from week 52 up to week 100, unless they had discontinued study treatment. at week 104, all patients who finished the core phase according to the protocol were asked to continue in an optional, exploratory extension phase. patients who achieved asas20 response at week 104 (core phase responders) were randomized to the following treatment groups (blinded) in the extension phase: * core phase responder 150 mg: secukinumab 150 mg (1 ml, 150 mg/ml) s.c. pfs and placebo (1 ml) s.c. pfs every four weeks; * core phase responder 300 mg: 2 injections with secukinumab 150 mg (1 ml, 150 mg/ml) s.c. pfs every four weeks. core phase non-responders (not achieving asas20 at week 104) were escalated to secukinumab 300 mg in an open-label manner. - core phase non-responder 300 mg: 2 injections with secukinumab 150 mg (1 ml, 150 mg/ml) s.c. pfs every four weeks open-label. starting from week 156 onward, a patient could switch to secukinumab 300 mg open-label based on the clinical judgment of disease activity by the investigator.

Eligibility criteria:
inclusion criteria: * male or non-pregnant, non-nursing female patients at least 18 years of age * diagnosis of axial spondyloarthritis according to ankylosing spondyloarthritis international society (asas) axial spondyloarthritis criteria * objective signs of inflammation (magnetic resonance imaging (mri) or abnormal c-reactive protein) * active axial spondyloarthritis as assessed by total bath ankylosing spondylitis disease activity index \>=4 cm * spinal pain as measured by bath ankylosing spondylitis disease activity index question #2 ≥ 4 cm (0-10 cm) at baseline * total back pain as measured by visual analogue scale ≥ 40 mm (0-100 mm) at baseline * patients should have been on at least 2 different non-steroidal anti-inflammatory drugs with an inadequate response * patients who have been on a tumor necrosis factor (tnf) α inhibitor (not more than one) must have experienced an inadequate response exclusion criteria: * patients with radiographic evidence for sacroiliitis, grade ≥ 2 bilaterally or grade ≥ 3 unilaterally * inability or unwillingness to undergo mri * chest x-ray or mri with evidence of ongoing infectious or malignant process * patients taking high potency opioid analgesics * previous exposure to secukinumab or any other biologic drug directly targeting interleukin-17 (il-17) or il-17 receptor * pregnant or nursing (lactating) women

Keywords: non-radiographic spondyloarthritis axial spondyloarthritis ankylosing spondylitis