AB0701 REAL-WORLD EXPERIENCE OF SECUKINUMAB FOR AXIAL SPONDYLOARTHRITIS: SPECIFIC POPULATION CHARACTERISTICS
Authors: Valentina Emperiale, Jose Campos Esteban, Carolina Merino Argumánez, Javier Bachiller-Corral, Marta Valero, Beatriz Joven-Ibáñez, María Martín, Ana Pérez Gómez
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> IL-17 inhibition has been proved effective in patients with ankylosing spondylitis (AS) in clinical trials and it has been added to the most recent national and international treatment guidelines. However, real-world data of its use is still scarce. <h3>Objectives</h3> This study aims to describe the axial spondyloartrhtitis (AxSpA) population receiving secukinumab therapy under non-experimental conditions. <h3>Methods</h3> Multicentric observational, retrospective, longitudinal study conducted in 4 tertiary hospitals of the Madrid region. Patients over 18 y.o. With clinical diagnosis of axSpa and having received at least one dose of secukinumab were included. Medical records were reviewed to collect demographic and clinical data related to axSpA, its features and treatment. Descriptive statstic analysis with measures of central tendency and measures of variability was performed. <h3>Results</h3> 143 patients, of which 68 women (47.6%) were included. Mean age was 50.6 y.o.(26-74) and average duration of the disease was 12.4 years (1-54). 105 aS patients (73.4%) and 38 non radiographic axSpA patients (26.6%). 85 of them were HLAB27 positive (62%) Observed comorbidities were hypertension (37pt, 25.8%), diabetes mellitus (12pt, 8.4%), dyslipidemia (43 pt,30.1%) and active smoking (41pt,28.7%) average BMI was 27.1 (15.8-43.4), with an obesity rate of 27.6% (29pt). Other comorbidities highlighted were ischemic heart disease (10pt, 7%), HBV infection (10pt, 7.5%), malignancy (14pt, 9.8%) and renal transplantation (2 pt, 1.4%). No HVC nor HIV infections were detected. In terms of axial disease, 97 (65.7%) patients showed grade 2 or higher sacroilitis. In sacroiliac joint MRI studies 35 patients (42.7%) had acute and chronic lesions, 13 (15.9%) had acute lesions, 17 (20.7%) had chronic lesions and 17 (20.7%) were normal. Syndesmophytes were present in 49 patients (34.5%) and hip arthropathy in 15 patients (11.4%). In addition, peripheral disease was present: 77 patients (53.8%) had arthritis, 80 patients (55.9%) had enthesitis and 9 patients (6.3%) showed dactilitis. Joint erosions in hand and feet X-rays were reported in 6 patients (6.8%). Extraarticular SpA features found were inflammatory bowel disease in 3 patients (2.1%), uveitis in 17 pts (11.9%) and psoriasis in12 pts (8.4%). 2 patients (1.4%) presented secondary amiloidosis. Regarding previous treatments, 97.2% had used NSAIDs and 38.5% glucocorticoids. 100 patients (84.1%) had received DMARDs, particularly sulfasalazine (84 pts, 58.7%). 38 patients were naïve to biologic therapy (26.6%); 36 (34.3%) had been exposed to one bDMARD, 39 (37.1%) to two and 30 (28.6%) to three or more. Besides all TNF inhibitors, 13 treatments with abatacept, tocilizumab, rituximab or ustekinumab were recorded. Average baseline BASDAI was 6.54 (0.4-12.8), and 5.01 (0-10) after 6 mo SCK therapy. Baseline BASFI was 5.8 (0.4-10) and 4.8 (0-9.6) at 6 months. Adverse events did not differ from those reported in clinical trials. <h3>Conclusion</h3> Population receiving SCK in real-world setting is different to clinical trials: more complex patientes, with higher disease activity, higher use of previous bDMARDs and higher comorbidity, particularly cardiovascular risk, infections or malignancy that could preclude the use of other biologic therapies. A relevant percentage of off-label prescription in nrAxSpA is reported. Further studys are needed to characterize this population and its clinical response and tolerability to SCK therapy. <h3>Disclosure of interests</h3> Valentina Emperiale: None declared, Jose Campos Esteban: None declared, Carolina Merino argumánez: None declared, Javier Bachiller-Corral: None declared, Marta Valero: None declared, Beatriz Joven-Ibáñez Speakers bureau: Celgene, Novartis, MSD, Pfizer, abbVie, and Janssen, María Martín: None declared, ana Pérez Gómez: None declared