ascalate: treat-to-target in axial spondyloarthritis

Conditions: Axial Spondyloarthritis

Summary: this was a randomized, parallel-group, open-label, multicenter study in patients with active axspa. the aim of the study was to demonstrate that the efficacy of a t2t approach (with secukinumab as a first-line biologic) was superior to a soc approach in terms of achieving strong clinical efficacy in patients with active axspa who were naïve to biological therapy and who had an inadequate response to prior non-steroidal anti-inflammatory drug (nsaid) treatment.

the study included an 8-week screening period, a 36-week treatment period, and a 20-week safety follow-up period. neither investigators nor patients were blinded. the primary endpoint was the percentage of patients achieving an asas40 response at week 24. at baseline, patients were randomized equally to one of two treatment groups (t2t or soc). patients were evaluated every 12 weeks from baseline through to week 36. safety evaluations were included in the regular visits; in addition, a safety follow-up visit was performed 20 weeks after the last study visit (i.e. week 36) and took place at week 56 for patients completing the study according to the protocol. patients assigned to the soc treatment group received soc treatment at the discretion of the investigator in accordance with current clinical practice. patients assigned to the t2t treatment group received first line biological treatment with secukinumab 150 mg. responders were defined as those patients with an asdas clinically important improvement of ≥ 1.1. at week 12 responders continued secukinumab 150 mg, whereas treatment was escalated to 300 mg for non-responders. at week 24, disease activity was assessed again. patients who qualify as responders continued the treatment they received prior (either secukinumab 150 mg or 300 mg), patients who were non-responders at week 24 were escalated in treatment: patients who received secukinumab 300 mg before were switched to adalimumab, and patients who received secukinumab 150mg before were escalated to secukinumab 300mg.

Eligibility criteria:
inclusion criteria: * diagnosis of axial spondyloarthritis, axspa (either non-radiographic axial spondyloarthritis or radiographic axial spondyloarthritis) fulfilling the ankylosing spondyloarthritis international society classification criteria for axspa * active disease as defined by having an ankylosing spondylitis disease activity score ≥ 2.1 at screening and baseline despite concurrent non-steroidal anti-inflammatory drug (nsaid) therapy, or intolerance/contraindication to nsaids. * objective signs of inflammation at screening as defined by: magnetic resonance imaging (mri) of sacroiliac joints performed up to 3 months prior to screening showing acute inflammatory lesion(s), or elevated quick c-reactive protein (crp) (\> 5 mg/l), or mri showing acute inflammatory lesion(s) in the sacroiliac joints and spine performed during screening period. * inadequate response to nsaids exclusion criteria: * previous exposure to secukinumab or other biologic drug directly targeting interleukin(il)-17 or il-17 receptor. * patients who have previously been treated with tumor necrosis factor alpha inhibitors (investigational or approved). * patients treated with any cell-depleting therapies. * active ongoing inflammatory diseases or underlying metabolic, hematologic, renal, hepatic, pulmonary, neurologic, endocrine, cardiac, infectious or gastrointestinal conditions, which in the opinion of the investigator immunosuppressed the patient and/or places the patient at unacceptable risk for participation in an immunomodulatory therapy. * history of clinically significant liver disease or liver injury * history of renal trauma, glomerulonephritis, or patients with one kidney only, or a serum creatinine level exceeding 1.8 mg/dl (159.12 μmol/l). * active systemic infections during the last 2 weeks (exception: common cold) prior to randomization. * history of ongoing, chronic or recurrent infectious disease or evidence of tuberculosis (tb) infection * patients positive for human immunodeficiency virus, hepatitis b or hepatitis c * life vaccinations within 6 weeks prior to baseline or planned vaccination during study participation until 12 weeks after last study treatment administration. other protocol-defined inclusion/exclusion criteria may apply.

Keywords: axial spondyloarthritis axspa treat-to-target t2t secukinumab ain457 non-radiographic axial spondyloarthritis nr-axspa radiographic axial spondyloarthritis r-axspa