THU0380 SECUKINUMAB IS FREQUENTLY PREFERRED IN MULTI ANTI-TNF RESISTANCE SPONDYLOARTHRITIS PATIENTS: HUR-BIO REAL LIFE RESULTS
Authors: B. Armagan, L. Kiliç, G. K. Yardimci, E. Bilgin, B. Farisoğullari, E. C. Bolek, E. Duran, O. Karadag, A. Akdoğan, Ş. A. Bilgen, A. İ. Ertenli, U. Kalyoncu, S. Kiraz
Journal: Annals of the Rheumatic Diseases (2020)

Background: Anti-TNF agents have been used for the last two decades. However, targeting interleukin-17 (secukinumab (SEC)) is a relatively novel treatment option for spondyloarthritis (SpA). Therefore, SEC is frequently preferred after multi anti-TNF agents, in real life. Objectives: The objective of this study was to assess the retention rate and response of SEC in anti-TNF naïve and anti-TNF resistance patients in real life experience. Methods: HUR-BIO is a monocentric database of biologics including 2886 SpA patients, since 2005. SEC is approved at May 2018 in Turkey and 147 patients have used SEC by January 2020. Demographic and clinical data were obtained from HUR-BIO registry. SpA patients were classified as ankylosing spondylitis (AS) and non-radiographic SpA (nrAxSpA). Response and retention rate of SEC were determined regarding to anti-TNF naïve vs anti-TNF resistance patients. Kaplan-Meier analysis was used to estimate SEC retention rates. Results: In total, 147 axial SpA patients (96 (65.3%) AS and 51 (34.7%) nrAxSpA) were analyzed. Overall, 23/147 (15.7%) patients were anti-TNF naïve, 27 (18.4%) patients were 1 anti-TNF failure and 97 (65.9%) patients were ≥2 anti-TNF failure. Baseline characteristics of patients and the main causes of discontinuation of anti-TNF agents were shown in table. Median duration of SEC usage was 7.9 (min-max, 3.0-19.8) months in AS and 6.7 (min-max, 3.0-19.8) months in nrAxSpA group (p=0.365). SEC survival at 12 months was similar between AS and nrAxSpA patients (56% vs %52, p=0.315) (not shown).SEC survival was similar among anti-TNF naïve, one anti-TNF failure and ≥2 anti-TNF failure patients (Figure). BASDAI 50 response was reached in 61.5% of anti-TNF naïve, 42.1% of one anti-TNF failure and 43.2% of ≥2 anti-TNF failure patients at the last control (p=0.452). Patients who used ≤ 1 anti-TNF agent had a higher drug survival rate (%69 vs %46, p=0.027) at 1 year, in comparison with patients who used &gt; 1 anti-TNF agents before SEC(not shown). Figure. Secukinumab survival in anti-TNF naïve, one anti-TNF failure and ≥2 anti-TNF failure patients Conclusion: For SpA, SEC is a relatively new player in biological era. When SEC launched for new treatment option, it is preferred mostly (almost 2/3) in multi anti-TNF resistance patients. Moreover, those difficult patients’ (usually female) treatment response and retention rate were not satisfactory than biological naïve patients. Table. Baseline characteristics of patients and the main causes of discontinuation of anti-TNF agents Anti-TNF naive, n=23 One anti-TNF failure, n=27 ≥2 anti-TNF failure, n=97 p Age, years, mean±SD 46.0 ± 11.2 42.4 ± 8.4 44.3 ±9.9 0.611 Female, n (%) 7 (30.4) 15 (55.6) 61 (62.9) 0.019 Disease duration, months, median (min-max) 72 (12-408) 102 (12-300) 120 (12-396) 0.054 Disease duration ≥5 years, n (%) 12 (52.2) 18 (66.7) 72 (74.2) 0.112 Secukinumab indications &lt;0.0001 -Anti-TNF inefficacy, n (%) - 9 (33.4) 80 (82.5) -Anti-TNF adverse event, n (%) - 10 (37.0) 16 (16.5) -Others, n (%) - 8 (29.6) 1 (1.0) History of smoking, n (%) 14 (60.9) 17 (63.0) 54 (55.7) 0.754 History of uveitis, n (%) 5 (21.7) 7 (25.9) 10 (10.3) 0.081 Baseline BASDAI 54 (10-96) 54.5 (0-88) 60 (0-100) 0.307 Baseline BASFI 53 (10-78) 38 (0-94) 55 (0-100) 0.142 Baseline back pain VAS 55 (0-100) 50 (0-100) 70 (0-100) 0.113 ESR, mm/h, median (min-max) 21 (2-120) 24.5 (2-107) 20 (2-84) 0.621 CRP, mg/dL, median (min-max) 0.7 (0.1-8.4) 1.3 (0.1-10.4) 0.7 (0.1-30.8) 0.439 Syndesmophytes on X-ray, n (%) 8 (66.7)* 8 (47.1) 16 (22.9)* 0.019 *p=0.007 Disclosure of Interests: Berkan Armagan: None declared, Levent Kiliç: None declared, Gözde Kübra Yardimci: None declared, Emre Bilgin: None declared, Bayram Farisoğullari: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB, Sedat Kiraz: None declared