1
|
Sivera F, Núñez-Monje V, Campos-Fernández C, Balaguer-Trull I, Robustillo-Villarino M, Aguilar-Zamora M, Garijo-Bufort M, López-Gómez JM, Peña-González C, de la Morena I, Bedoya-Sanchís D, Yankova-Komsalova L, Conesa-Mateos A, Martínez-Cristóbal A, Navarro-Blasco FJ, Senabre-Gallego JM, Alegre-Sancho JJ. Real-world experience with secukinumab in the entire axial spondyloarthritis spectrum. Front Med (Lausanne) 2023; 10:1156557. [PMID: 37250652 PMCID: PMC10213893 DOI: 10.3389/fmed.2023.1156557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Background Secukinumab is a biologic disease-modifying antirheumatic drug (bDMARD) that has demonstrated efficacy in the treatment of axial spondyloarthritis (axSpA, i.e., ankylosing spondylitis and non-radiographic axSpA) across various clinical trials. However, data of secukinumab in clinical practice is still limited. Here, we aimed to provide real-world data on secukinumab use, effectiveness, and persistence in axSpA. Patients and methods Retrospective, multicenter study of patients with a diagnosis of axSpA treated with secukinumab at 12 centers up to June 2021 in the Valencian Community (Spain). Information was gathered on BASDAI measurement, pain, patient and physician global assessment (ptGA, phGA) using a 100-mm visual analog scale (VAS), persistence and other secondary variables by treatment line (first, second, and ≥ third) for up to 24 months. Results 221 patients were included (69% men; mean age [standard deviation, SD]: 46.7 [12.1] years old). Secukinumab was used as a first-line bDMARD in 38% of patients, as a second-line in 34% and as a ≥ hird-line in 28%. The percentage of patients achieving low disease activity (BASDAI<4) increased from 9% at baseline to 48% at month 6 and was maintained (49%) up to month 24. The greatest improvement in BASDAI was observed in naïve patients (month 6: -2.6; month 24: -3.7), followed by second-line (month 6: -1.9; month 24: -3.1) and ≥ third-line (month 6: -1.3; month 24: -2.3) patients. Reductions in mean pain VAS (-23.3; -31.9), ptGA (-25.1; -31.9) and phGA (-25.1; -31) were also observed at 6 and 24 months. Secukinumab showed an overall 12-months persistence rate of 70% (95% confidence interval [CI]: 63-77%) and a 24-months persistence rate of 58% (95% CI, 51-66%). Patients receiving first-line secukinumab had the highest 24-months persistence rate (p = 0.05). Conclusion Secukinumab improved disease activity in axSpA patients, especially in naive, and second-line patients, which was accompanied by high persistence rates up to 24 months.
Collapse
Affiliation(s)
- Francisca Sivera
- Rheumatology Department, Hospital General Universitario de Elda, Alicante, Spain
- Departament of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | | | | | | | | | | | | | | | | | - Isabel de la Morena
- Rheumatology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Diego Bedoya-Sanchís
- Rheumatology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Arantxa Conesa-Mateos
- Rheumatology Department, Hospital General Universitari de Castelló, Castellón, Spain
| | | | | | | | | |
Collapse
|
2
|
Maksymowych WP, Inman RD, Bessette L, Rahman P, Rampakakis E, Asin-Milan O, Rachich M, Marrache AM, Lehman AJ. Sustained low functional impairment in axial spondyloarthritis (axSpA): which are the primary outcomes that should be targeted to achieve this? Arthritis Res Ther 2023; 25:70. [PMID: 37118833 PMCID: PMC10148455 DOI: 10.1186/s13075-023-03055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/20/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES To (i) determine whether sustained disease activity states, as measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), impact function, and (ii) evaluate characteristics predicting sustained low functional impairment in a prospective axial spondyloarthritis (axSpA) cohort. METHODS Biologic Treatment Registry Across Canada (BioTRAC) was a multi-center, prospective registry that collected real-world data on axSpA patients receiving infliximab or golimumab between 2006 and 2017. Generalized estimating equations (GEE) were used to test baseline characteristics, treatment, and duration (at 6 and 12 months vs. only at 6 or 12 months vs. neither) of low BASDAI (< 3), ASDAS-inactive disease (ID)(< 1.3), and ASDAS-low disease activity (LDA) in predicting sustained low Bath Ankylosing Spondylitis Functional Index (BASFI)(< 3) between 12 and 18 months. The adjusted impact of achieving low disease state at 6 and/or 12 months on BASFI at 18 months was analyzed by generalized linear models. RESULTS Eight hundred ten patients were enrolled. 33.7%, 13.4%, and 24.7% achieved sustained low BASDAI, ASDAS-ID, and ASDAS-LDA, respectively. In univariable GEE of baseline variables, age and baseline BASDAI, BASFI, and ASDAS significantly predicted sustained low BASFI. In multivariable GEE, sustained low BASDAI (p < 0.001), low BASDAI only at 6 or 12 months (p = 0.001), and baseline BASFI (p < 0.001) were the only predictors of sustained low BASFI. Sustained ASDAS-ID (p = 0.040) and ASDAS-LDA (p < 0.001) were also predictors when forced into the model. Similar results were obtained when evaluating the BASFI score at 18 months. CONCLUSION Sustained BASDAI < 3 may be a valid and feasible target for a treat-to-target strategy in axSpA having function as treatment goal.
Collapse
Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, Division of Rheumatology, University of Alberta, 568 Heritage Medical Research Building, T6G 2S2, Edmonton, Canada.
- CARE Arthritis, Edmonton, Canada.
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Louis Bessette
- Department of Medicine, Université Laval, Quebec, QC, Canada
| | - Proton Rahman
- Faculty of Medicine, Memorial University, St John's, NL, Canada
| | | | | | | | | | | |
Collapse
|
3
|
Navarro-Compán V, Ermann J, Poddubnyy D. A glance into the future of diagnosis and treatment of spondyloarthritis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221111611. [PMID: 35898564 PMCID: PMC9310200 DOI: 10.1177/1759720x221111611] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
The last two decades have seen major developments in the field of
spondyloarthritis (SpA), but there are still important unmet needs to address.
In the future, we envisage important advances in the diagnosis and treatment of
SpA. In the diagnosis of SpA, the use of online and social media tools will
increase awareness of the disease and facilitate the referral of patients to
rheumatology clinics. In addition, more specific diagnostic tests will be
available, especially advanced imaging methods and new biomarkers. This will
allow most patients to be diagnosed at an early stage of the disease. In the
treatment of SpA, an increasing number of novel treatment targets can be
expected, most of which will be directed against intracellular enzymes. We hope
to see more strategy trials shaping treatment pathways in SpA and accommodating
principals of precision medicine. Approved treatment options will be available
for both axial and peripheral SpA. We also hope to intervene not only at the
inflammation level but also at the level of underlying immunological processes
that might be associated with a higher probability of long-standing remission if
not a cure. Finally, artificial intelligence techniques will allow for the
analysis of large-scale data to answer relevant research questions for the
diagnosis and management of patients with SpA.
Collapse
Affiliation(s)
| | - Joerg Ermann
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (Including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
| |
Collapse
|
4
|
Proft F, Schally J, Brandt HC, Brandt-Juergens J, Rüdiger Burmester G, Haibel H, Käding H, Karberg K, Lüders S, Muche B, Protopopov M, Rademacher J, Rios Rodriguez V, Torgutalp M, Verba M, Zinke S, Poddubnyy D. Validation of the ASDAS with a quick quantitative CRP assay (ASDAS-Q) in patients with axial SpA: a prospective multicentre cross-sectional study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221085951. [PMID: 35368376 PMCID: PMC8972926 DOI: 10.1177/1759720x221085951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/18/2022] [Indexed: 12/26/2022] Open
Abstract
Objectives: The objective of the study was to validate the Ankylosing Spondylitis Disease Activity Score (ASDAS) based on a quick quantitative C-reactive protein (qCRP) assay (ASDAS-Q) in a multicentre, prospective, cross-sectional study in patients with axial spondyloarthritis (axial SpA). Methods: Disease activity assessment was performed in prospectively recruited patients with axial SpA. Routine laboratory CRP was determined in the central laboratory of each study centre, while quick qCRP and erythrocyte sedimentation rate (ESR) were measured locally. Consequently, ASDAS-CRP, ASDAS-Q using the qCRP and ASDAS-ESR were calculated. The absolute agreement on the disease activity category ascertainment was analysed with cross-tabulations and weighted Cohen’s kappa. Bland–Altman plots and intraclass correlation coefficients (ICCs) were used to analyse the criterion validity. Results: Overall, 251 axial SpA patients were included in the analysis. The mean qCRP value (6.34 ± 11.13 mg/l) was higher than that of routine laboratory CRP (5.26 ± 9.35 mg/l). The ICC for routine laboratory CRP versus qCRP was 0.985 [95% confidence interval (CI): 0.972–0.991]. Comparing ASDAS-Q with ASDAS-CRP, 242 of 251 (96.4%) patients were assigned to the same disease activity categories with a weighted Cohen’s kappa of 0.966 (95% CI: 0.943–0.988) and ICC of 0.997 (95% CI: 0.994–0.999). Conclusions: ASDAS-Q showed an almost perfect agreement with ASDAS-CRP in the assignment to specific disease activity categories. Consequently, ASDAS-Q using the qCRP value can be applied as an accurate and quickly available alternative to ASDAS-CRP, thus facilitating the implementation of the treat-to-target concept in clinical trials and clinical routine.
Collapse
Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, Berlin 12203, Germany
| | - Julia Schally
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Gerd Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hildrun Haibel
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henriette Käding
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Karberg
- Praxis für Rheumatologie und Innere Medizin, Berlin, Germany
| | - Susanne Lüders
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhard Muche
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Rademacher
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Valeria Rios Rodriguez
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maryna Verba
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| |
Collapse
|
5
|
Wendling D, Claudepierre P, Goupille P, Pham T, Prati C. Tight control and treat-to-target in axial spondyloarthritis. Where are we? Joint Bone Spine 2021; 89:105263. [PMID: 34506936 DOI: 10.1016/j.jbspin.2021.105263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Daniel Wendling
- Department of rheumatology, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4266, EPILAB, université de Franche-Comté, Besançon, France.
| | - Pascal Claudepierre
- EpiDermE, université Paris Est Créteil, 94010 Créteil, France; Service de rhumatologie, hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Philippe Goupille
- Department of rheumatology, CHRU de Tours, Tours, France; EA 7501, GICC, université de Tours, Tours, France
| | - Thao Pham
- Department of rheumatology, Aix Marseille université, CHU Sainte-Marguerite, AP-HM, Marseille, France
| | - Clément Prati
- Department of rheumatology, CHRU de Besançon, boulevard Fleming, 25030 Besançon, France; EA 4267, PEPITE, université de Franche-Comté, FHU INCREASE, Besançon, France
| |
Collapse
|