FRI0337 REAL WORLD SECUKINUMAB DRUG-SURVIVAL IN PSORIATIC ARTHRITIS
Authors: T. Eviatar, D. Zisman, M. Lidar, T. Reitblat, A. Balbir-Gurman, O. Elkayam
Journal: Annals of the Rheumatic Diseases (2020)

Background: Secukinumab (Cosentyx) is a human IgG1 monoclonal antibody that selectively binds to and neutralizes IL-17A. Several prospective randomized control trials have demonstrated the efficacy and safety of secukinumab in PsA, but there is a paucity of real life data in the PsA population. Objectives: To prospectively study secukinumab’s safety, efficacy, and tolerability in the cohort of PsA patients from the Israeli registry of inflammatory diseases. Methods: PsA patients fulfilling the CASPAR criteria from the Israeli registry of inflammatory diseases were included in the analysis, from 2010 to November 2019. The primary end point was secukinumab drug survival compared to other available TNFi drug. Bivariate and multivariate analysis of the factors that affect the drug event free survival was done by cox regression analysis. Drug survival according to treatment line (all treatment lines, or 2 nd and above treatment lines) was examined using Kaplan-Meier curves. Results: Four hundred and four PsA patients were included, which had 709 treatment episodes (initiations) during the study period. Ninety patients had been treated with secukinumab (22%). Secukinumab treated patients were significantly older at time of initiation of treatment, and disease duration was longer. Secukinumab was more likely to be a second, third or forth line of treatment than the TNFi. . Time to an inefficacy event was longer for secukinumab than any other anti-TNF treatment. As a first line treatment secukinumab had drug survival similar to other TNFi. As a second or third line treatment, secukinumab had a better drug survival than other TNFi. Methotrexate did not have a significant effect on inefficacy event rate in combination treatment with secukinumab. Secukinumab, as infliximab and golimumab, was as effective in the higher BMI group as it was in the normal weight to obese groups. Smokers (current or past) did better on secukinumab than on TNFi. Secukinumab had a similar rate of adverse events compared to TNFi. Conclusion: In this multicenter real world study, secukinumab had a comparable drug survival to TNFi. As a second and beyond line of treatment secukinumab had a better drug survival and lower HR for an inefficacy event. IL-17 inhibition is an effective mechanism of action to treat PsA in real life, and should be used more frequently as a first and second line treatment. Tables and a graph: Table 1. Inefficacy events according to treatment and drug survival in 1, 2, and 3 years. Drug Total episodes Inefficacy events (%) HR 95% CI P value 1 st year survival % 2 nd year survival % 3 rd year survival % SEC 90 30 (33.3) 1 0.095 86 58 41 ETA 202 86 (42.6) 1.16 0.77-1.76 0.479 75 58 50 IFX 87 34 (39.1) 1.01 0.62-1.65 0.966 82 64 52 ADA 227 103 (45.4) 1.36 0.9-2.04 0.143 71 53 46 GOL 103 103 (50) 1.64 1.05-2.59 0.031 63 50 42 Table 2. inefficacy events and drug survival according to line of treatment. Drug Total episodes Inefficacy events (%) HR 95% CI P value 1 st year survival % 2 nd year survival % 3 rd year survival % 1 st line SEC 13 2 (15.4) 1 0.216 92 92 76 ETA 130 55 (42.3) 3.25 0.79-13.34 0.101 76 59 51 IFX 28 11 (39.3) 2.88 0.64-13.01 0.168 81 63 52 ADA 103 37 (35.9) 2.63 0.63-10.91 0.183 79 63 59 GOL 25 14 (56) 4.55 1.03-20 0.045 60 50 40 2 nd and 3 rd lines SEC 34 7 (20.6) 1 0.039 90 66 66 ETA 68 29 (42.6) 1.68 0.74-3.85 0.218 73 57 51 IFX 51 20 (39.2) 1.42 0.6-3.36 0.431 85 64 54 ADA 119 62 (52.1) 2.5 1.15-5.48 0.022 65 46 35 GOL 52 23 (44.2) 2.26 0.97-5.27 0.06 65 50 46 4 th line SEC 43 21 (48.8) 1 0.082 82 44 24 ETA 4 2 (50) 1.1 0.25-4.73 0.902 67 33 – IFX 8 3 (37.5) 0.83 0.25-2.79 0.762 69 69 – ADA 5 4 (80) 4.87 1.6-14.81 0.005 30 – – GOL 26 13 (50) 1.29 0.64-2.58 0.473 62 52 31 Figure 1. Cumulative survival without an inefficacy event of secukinumab compared to TNFα inhibitors regardless of treatment line. Disclosure of Interests: Tali Eviatar: None declared, Devy Zisman Consultant of: Novartis, Merav Lidar Consultant of: Novartis, Tatyana Reitblat Consultant of: Novartis, Alexandra Balbir-Gurman Consultant of: Novartis, Ori Elkayam Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Novartis, Jansen