Prediabetes remission after bariatric surgery: a 4-years follow-up study

BACKGROUND

Bariatric surgery leads to weight loss and to cardiometabolic risk improvement. Although prediabetes remission after bariatric surgery is biologically plausible, data on this topic is scarce. We aimed to assess prediabetes remission rate and clinical predictors of remission in a 4 year follow up period.

METHODS

Observational longitudinal study including patients with obesity and prediabetes who had undergone bariatric surgery in our centre. Prediabetes was defined as having a baseline glycated haemoglobin (A1c) between 5.7% and 6.4% and absence of anti-diabetic drug treatment. We used logistic regression models to evaluate the association between the predictors and prediabetes remission rate.

RESULTS

A total of 669 patients were included, 84% being female. The population had a mean age of 45.4 ± 10.1 years-old, body mass index of 43.8 ± 5.7 kg/m2, and median A1c of 5.9 [5.8, 6.1]%. After bariatric surgery, prediabetes remission rate was 82%, 73%, 66%, and 58%, respectively in the 1st, 2nd, 3rd, and 4th years of follow-up. Gastric sleeve (GS) surgery was associated with higher prediabetes remission rate than Roux-en-Y gastric bypass surgery in the 3rd year of follow-up. Men had a higher remission rate than women, in the 1st and 3nd years of follow-up in the unadjusted analysis. Younger patients presented a higher remission rate comparing to older patients in the 3rd year of follow-up.

CONCLUSION

We showed a high prediabetes remission rate after bariatric surgery. The remission rate decreases over the follow-up period, although most of the patients maintain the normoglycemia. Prediabetes remission seems to be more significant in patients who had undergone GS, in male and in younger patients.

COVID-19 Lockdown and Impact on 2-Year Weight Loss in a Bariatric Center

INTRODUCTION

The COVID-19 pandemic has led to a worldwide lockdown, which affected physical exercise habits, as well as having a detrimental effect on psychological health and follow-up visits of patients submitted to bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 lockdown on the 2-year weight loss of patients submitted to bariatric surgery in our center.

METHODS

This was an observational study comparing the weight loss of patients who underwent bariatric surgery from January to March 2020 with a control group submitted to surgery between January and March 2017. Percentage of total weight loss (% TWL) and excess weight loss (% EWL) were assessed 6, 12, and 24 months after surgery.

RESULTS

A total number of 203 patients were included in this study, 102 had bariatric surgery during the selected period in 2020 and 101 underwent surgery during the same period in 2017. There was no statistically significant difference in weight loss between the 2017 and 2020 groups which was reported as % TWL (mean 27.08 ± 7.530 vs. 28.03 ± 7.074, 33.87 ± 8.507 vs. 34.07 ± 8.979 and 34.13 ± 9.340 vs. 33.98 ± 9.993; p = 0.371) and % EWL (mean 66.83 ± 23.004 vs. 69.71 ± 17.021, 83.37 ± 24.059 vs. 84.51 ± 21.640 and 83.47 ± 24.130 vs. 84.27 ± 23.651; p = 0.506) at 6, 12, and 24 months post-surgery.

CONCLUSION

Despite social limitations imposed by the COVID-19 lockdown, we found no significant difference between weight loss at 2 years postoperatively in the 2020 group when compared with a control group who underwent bariatric surgery in 2017. These results show that the outcomes of bariatric surgery during the COVID-19 lockdown were comparable with those recorded before the pandemic, supporting the efficacy of bariatric procedures' metabolic effects during the first 2 years after surgery, regardless of lifestyle habits.

POS0937 MEASURE 2: SECUKINUMAB PROVIDES RAPID AND SUSTAINED RELIEF FROM KEY CLINICAL SYMPTOMS OF ACTIVE ANKYLOSING SPONDYLITIS IN TNFi-NAÏVE PATIENTS THROUGH 5 YEARS

Background

Ankylosing spondylitis (AS) is a chronic, inflammatory disease resulting in debilitating clinical symptoms such as pain (70–83%), stiffness (54–90%) and fatigue (53–62%).1-3 Secukinumab (SEC 150 mg) has demonstrated long-term efficacy across multiple indications and is approved for the treatment of active AS in adults who have had an inadequate response to NSAIDs.4,5

Objectives

The Phase 3 MEASURE 2 trial (NCT01649375) assessed long-term efficacy, safety and tolerability of SEC in patients (pts) with active AS. This post-hoc analysis was conducted specifically to evaluate long-term efficacy of SEC 150 mg on key clinical symptoms of pain, morning stiffness, physical function and fatigue in TNFi-naïve pts over 5 years.

Methods

The MEASURE 2 study design has been reported previously.5 This post-hoc analysis evaluated key clinical symptoms at baseline through Wk 260. Assessments included total and nocturnal back pain (visual analogue scale [0–100 mm]), overall spinal pain (neck, back, or hip) from BASDAI, and morning stiffness (average BASDAI). Physical function (SF-36 PCS, BASFI), fatigue (BASDAI, FACIT) and disease activity (ASDAS-CRP) are also reported. Data are presented as LS mean change (± SE) using mixed model repeated measures from Wks 4–16 and observed data (mean ± SD) from Wks 24–260.

Results

Of TNFi-naïve pts randomised to SEC 150 mg, 89 were included (SEC, n=44, placebo [PBO], n=45) in this analysis. Of these pts randomised to SEC 150 mg, 84% completed 5 years of treatment. Significantly greater improvements were observed in pts treated with SEC 150 mg vs PBO at Wk 16 and were sustained through 5 years (Figure 1; Table 1).

Table 1.

Pain, physical function and fatigue scores

EndpointTreatmentBL mean ± SD*Wk 16 LS mean, SE (p-value)Wk 52 ± SDWk 104 ± SDWk 156 ± SDWk 208 ± SDWk 260 ± SDBACK PAINTotal back painSEC66.86 ± 15.42-33.99, 3.42 (p=0.0000)-40.56 ± 24.35-37.74 ± 26.09-39.03 ± 26.65-37.77 ± 28.40-36.78 ± 29.76PBO67.69 ± 17.71-12.75, 3.46NANANANANANocturnal back painSEC66.84 ± 14.17-36.25, 3.50 (p=0.0000)-45.13 ± 23.92-40.54 ± 25.23-43.92 ± 25.10-41.13 ± 24.87-38.95 ± 28.91PBO63.87 ± 18.78-14.41, 3.54NANANANANAPHYSICAL FUNCTIONSF-36 PCSSEC34.87 ± 6.587.90, 0.98 (p=0.0012)8.44 ± 7.488.95 ± 7.878.98 ± 8.179.39 ± 8.398.55 ± 9.32PBO35.45 ± 6.513.23, 0.98NANANANANABASFISEC6.42 ± 1.95-2.89, 0.31 (p=0.0002)-3.38 ± 2.38-3.23 ± 2.39-3.10 ± 2.49-3.10 ± 2.47-2.86 ± 2.61PBO6.34 ± 1.99-1.18, 0.32NANANANANAFATIGUEOverall level (BASDAI)SEC7.00 ± 1.26-2.39, 0.34 (p=0.0095)-3.44 ± 2.32-3.30 ± 2.45-3.16 ± 2.61-3.12 ± 2.34-2.92 ± 2.71PBO7.18 ± 1.49-1.12, 0.34NANANANANAFACITSEC22.27 ± 8.0210.62, 1.26 (p=0.0052)12.14 ± 9.7611.00 ± 9.3710.79 ± 8.9112.39 ± 9.0910.64 ± 10.66PBO23.22 ± 7.945.48, 1.26NANANANANADISEASE ACTIVITYASDAS-CRPSEC3.73 ± 0.82-1.47, 0.14 (p=0.0000)-1.80 ± 1.16-1.66 ± 1.21-1.63 ± 1.35-1.69 ± 1.24-1.58 ± 1.36PBO3.89 ± 0.76-0.51, 0.14NANANANANA

*Baseline refers to mean ± SD of observed values. LS mean change using MMRM for Wk 16 and observed data (mean ± SD) from Wks 24–260. SEC 150 mg, N=44 and PBO, N=45. ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score - C-reactive protein; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BL, baseline; FACIT, Functional Assessment of Chronic Illness Therapy; LS, least square; MMRM, mixed-effects model repeated measures; NA, not available; PBO, placebo; SD, standard deviation; SEC, secukinumab; SF-36 PCS, Short Form-36 Physical Component Summary; Wk, week.

Conclusion

TNFi-naïve pts with active AS treated with SEC 150 mg experienced rapid improvements across a range of key clinical symptoms including pain, physical function and fatigue measures, that were sustained through 5 years.

References

[1]Deodhar A et al. 2020 BMC Rheumatol 2020;4:19

[2]Ward M et al. Arth Care Res 1999;12:247–55

[3]van Tubergen A et al. Arth Rheum 2002;47:8–16

[4]Cosentyx SmPC (2020) [Accessed: 24 Jan 22]

[5]Baeten D et al. N Eng J Med 2015;373:2534–48

Acknowledgements

This study was sponsored by Novartis Pharma. Medical writing support for the development of this abstract, under the direction of the authors, was provided by Laura Crocker (BMedSci, Hons) of Ashfield MedComms, an Ashfield Health company, and funded by Novartis Pharma

Disclosure of Interests

Karel Pavelka Speakers bureau: AbbVie, Pfizer, Roche, Eli Lilly, BMS, MSD, USB, Alan Kivitz Shareholder of: Amgen, Novartis, Gilead, Pfizer, Glaxosmithkline, Sanofi, Speakers bureau: AbbVie, Merck, Celgene, Novartis, Flexion, Pfizer, Gilead, Sanofi, UCB, Horizon, Consultant of: AbbVie, Celgene, Janssen, Boehringer Ingelheim, Pfizer, Flexion, Regeneron, Gilead, Sanofi, Sun Pharma Advanced Research, UCB, Merck, Novartis, Horizon, Renato Calheiros Employee of: I am currently an employee for Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Erhard Quebe-Fehling Shareholder of: Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Novartis, Employee of: Novartis, Ricardo Blanco Speakers bureau: AbbVie, Amgen, Bristol-Myers, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and Sanofi, Consultant of: Astra-Zeneca, Galapagos, Janssen, Novartis, Pfizer, Grant/research support from: AbbVie, and Roche

AB0788 The International Map of Axial Spondyloarthritis (IMAS): a US patient perspective on diagnosis and burden of disease

Background

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease encompassing radiographic (traditionally known as ankylosing spondylitis) and non-radiographic forms that lead to chronic pain, structural damage, and disability.1 The International Map of Axial Spondyloarthritis (IMAS) survey is an initiative developed to generate insights into the real-life experiences of people living with axSpA to ultimately improve quality of life.2

Objectives

To assess the burden and daily experience of patients with axSpA in the United States.

Methods

The IMAS survey generates a report on patient-reported aspects of disease burden and experience with axSpA using adaptations of the original Atlas of axSpA questionnaire developed in collaboration with patients, the Axial Spondyloarthritis International Federation, and clinical academic experts. In this US adaptation of the IMAS survey, a 30-minute quantitative online survey was administered to US patients aged ≥18 years who completed screening questions, self-reported having been diagnosed with axSpA by a healthcare provider, and were under the care of a healthcare provider between July 22, 2021, and November 10, 2021. Survey questions were tailored to reflect differences in the US healthcare systems and the availability of treatments. This analysis presents a portion of the US data describing patient demographics, clinical characteristics, journey to axSpA diagnosis, and the emotional impact and overall burden of disease on quality of life using the General Health Questionnaire 12 (GHQ-12), the Assessment of SpondyloArthritis international Society – Health Index (ASAS-HI), and a global limitation index of 18 activities of daily living. All results were reported descriptively using summary statistics.

Results

Survey data from 228 US patients with axSpA were collected in this analysis. The mean age was 45 years, 60% of patients were female, and the mean BMI was 27.7 kg/m2 (Table 1). Participating patients had an average of 5.6 comorbidities, with anxiety (43%), depression (41%), and hypertension (32%) as the most commonly reported comorbidities. Among all patients, the mean age at onset of first symptoms was 26 years and the mean age at diagnosis was 35 years; overall, mean diagnostic delay was greater in female than in male patients (11.2 vs 5.2 years; Figure 1A). According to the validated GHQ-12, over half of the patients (57%) were at risk for psychological distress (GHQ-12 score ≥3; Figure 1B). Patients who were older (>40 years old), physically inactive, or who had active disease (BASDAI ≥4) were at risk for psychological distress. Most patients (82%) suffered from a high degree of impairment (ASAS-HI ≥6), 47% had a medium or high limitation in activities of daily living, and 46% of patients were not employed at the time of the survey.

Table 1.

Patient Demographic and Clinical Characteristics

CharacteristicPatients with axSpA(N=228)Mean age, years45Female, %60White, %86Mean body mass index, kg/m227.7Nonsmoker, %62Alcohol consumption behavior, %Never19Every day9Mean number of comorbidities5.6Common comorbidities (≥20% of patients), %aAnxiety43Depression41Hypertension32Obesity/overweight31Sleep disorders30Hypercholesterolemia29Uveitis24Psoriatic arthritis23Fibromyalgia20Spinal or other fractures20Psoriasis20Employed, %54

axSpA, axial spondyloarthritis.

aRespondents could have selected ≥1 answer.

Conclusion

This study showed that a high proportion of US patients with axSpA report impaired function and are at risk for psychological distress. Patients also experienced a substantial delay in the time to axSpA diagnosis, with longer delays than those reported in the European Union. Delays were twice as long in women compared to men. These findings highlight the large impact of disease on daily activities and mental distress in US patients with axSpA.

References

[1]Sieper J, Poddubnyy D. Lancet. 2017;390:73-84.

[2]Garrido-Cumbrera M, et al. Curr Rheumatol Rep. 2019;21:19.

Acknowledgements

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Medical writing support was provided by Charli Dominguez, PhD, of Health Interactions, Inc, Hamilton, NJ, USA, and was funded by Novartis Pharmaceuticals Corporation. This abstract was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.

Disclosure of Interests

Marina Magrey Consultant of: Received consulting fees from Eli Lilly and Novartis, Grant/research support from: Received research grants from AbbVie, Amgen, and UCB, Jessica A. Walsh Consultant of: Received consulting fees from Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Grant/research support from: Received research funding from AbbVie, Merck, and Pfizer, Sandra Flierl Employee of: Employee of Ipsos, Renato Calheiros Employee of: Employee of Novartis, David Wei Employee of: Employee of Novartis, Muhammad Asim Khan Consultant of: Has served as a consultant for Novartis

AB0759 Efficacy of secukinumab in patients with non-radiographic axial spondyloarthritis: analysis by symptom duration and age

Background

Patients (pts) with axial spondyloarthritis (axSpA) often experience delayed diagnosis, which can lead to treatment delay1. However, earlier diagnosis and treatment of axSpA pts can lead to a greater clinical response2. Secukinumab (SEC) 150 mg has demonstrated sustained improvement in signs and symptoms over 2 years in non-radiographic (nr)-axSpA pts3.

Objectives

To assess the efficacy of SEC in pts with nr-axSpA [tumour necrosis factor (TNF) naïve] by subgroups of younger versus (vs) older pts and early vs late symptom duration of back pain.

Methods

PREVENT (NCT02696031) is a phase 3, randomised study in pts with nr-axSpA and detailed study design is reported previously4. In this post hoc analysis, efficacy outcomes including Assessment of SpondyloArthritis international Society 40 (ASAS40), ASAS partial remission (ASAS PR), Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP) inactive disease (ID) and low disease activity (LDA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the proportion of pts meeting the minimal clinically important difference criteria for total back pain (improvement of ≥50%) were assessed in the TNF naïve population. Age categories included 4 approximately equally distributed age groups (18 to 33, 34 to 42, 43 to 51 and ≥52 years). The categories for time since onset of back pain as a surrogate of disease symptoms and sign, was based on patients’ distribution and the hypothesis that patients with shorter disease duration will present better results (≤2, >2 to 5, >5 to 10 and >10 years). Missing responses were imputed as non-response up to Week (Wk) 16 and reported as observed at Wks 52 and 104. Data is presented here for categories 18-33 vs ≥52 years and patients with symptom duration ≤2 vs >10 years.

Results

At Wk 104, greater improvements in ASAS40 scores were reported in younger (18-33 years) vs older age categories (>52 years) treated with SEC and also in patients with shorter disease duration (≤2 years) when compared to long term disease (Figure 1 and Table 1).

Table 1.

Efficacy responses with SEC up to Week 104 based on age and symptom duration

Age 18-33 yearsAge >52 years≤2 years of back pain>10 years of back painSEC 150 mg LD (N=61)SEC 150 mg NL (N=59)PBO (N=61)SEC 150 mg LD (N=25)SEC 150 mg NL (N=33)PBO (N=28)SEC 150mg LD (N=51)SEC 150 mg NL (N=33)PBO (N=47)SEC 150 mg LD (N=50)SEC 150 mg NL (N=46)PBO (N=49)ASDAS-CRP ID and LDA50.8*55.9*34.4*36.0*39.4*21.4*51.0*48.5*40.4*44.0*30.4*26.5*77.4#81.1#72.2#45.8#46.7#33.3#77.3#60.0#77.3#53.3#48.7#37.2#71.7†70.2†77.6†50.0†57.1†60.9†74.4†69.2†82.1†55.3†53.3†53.8†BASDAI 5045.9*47.5*27.9*28.0*36.4*17.9*45.1*51.5*29.8*34.0*23.9*20.4*77.8#71.7#72.2#37.5#53.3#37.0#75.6#60.0#75.0#46.7#46.2#43.2#73.5†72.3†77.6†47.6†60.9†52.2†78.0†65.4†76.9†53.8†53.1†51.3†ASAS PR29.5*32.2*8.2*12.0*12.1*7.1*27.5*24.2*8.5*18.0*10.9*12.2*41.5#50.9#38.9#12.5#20.0#22.2#45.5#40.0#38.6#22.2#23.1#20.5#46.9†44.7†59.2†23.8†31.8†21.7†56.1†34.6†46.2†25.6†25.8†23.1†Total back pain50.8*50.8*27.9*24.0*30.3*32.1*51.0*48.5*36.2*32.0*23.9*32.7*74.1#75.5#72.2#58.3#46.7#44.4#73.3#63.3#72.7#53.3#48.7#47.7#71.4†68.1†79.6†61.9†52.2†52.2†75.6†69.2†74.4†61.5†50.0†59.0†

Data is presented as % of responders. Symbols are used to denote the Weeks. *Week 16; #Week 52; †Week 104

. All patients received open-label SEC 150 mg treatment after Week 52 up to Week 104

. ASDAS-CRP ID and LDA (ASDAS-CRP <2.1); Total back pain improvement ≥50%

. LD, loading dose; NL, without loading; PBO, placebo

Conclusion

Efficacy responses were numerically higher with SEC in patients with nr-axSpA with shorter symptom duration and in younger age. These data suggest that earlier treatment improves patient outcomes in nr-axSpA.

References

[1]Lapane KL, et al. BMC Fam Pract. 2021;22(1):251

[2]Poddubnyy D, Sieper J. Curr Rheumatol Rep. 2020;22(9):47

[3]Poddubnyy D, et al. Ann Rheum Dis. 2021;80 (suppl1):707

[4]Deodhar A et al. Arthritis Rheumatol. 2021;73(1):110-120

Disclosure of Interests

Atul Deodhar Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Glaxo Smith & Kline, Janssen, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Lilly, MSD, Novartis, Pfizer, UCB, Roche, Consultant of: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, UCB, Roche, Grant/research support from: AbbVie, MSD, Novartis, Pfizer, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma, MSD and Lilly, Consultant of: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, UCB pharma and MSD, Grant/research support from: AbbVie, MSD, and Roche, Stephen Hall Speakers bureau: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Consultant of: Novartis, Merck, Janssen, Pfizer, Eli Lilly, and UCB, Grant/research support from: AbbVie, UCB, Janssen, and Merck, Marina Magrey Consultant of: Eli Lily, Novartis, Grant/research support from: AbbVie, UCB and Amgen, Erhard Quebe-Fehling Shareholder of: Shareholder of Novartis, Employee of: Novartis, Renato Calheiros Shareholder of: Shareholder of Novartis, Employee of: Novartis, Patricia Pertel Shareholder of: Shareholder of Novartis, Employee of: Novartis, Helena Marzo-Ortega Speakers bureau: AbbVie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Takeda and UCB, Consultant of: AbbVie, Celgene, Janssen, Moonlake, Lilly, Novartis, Pfizer and UCB, Grant/research support from: Janssen, Novartis and UCB

OP0023 A RANDOMIZED, DOUBLE-BLIND TRIAL COMPARING SECUKINUMAB 300 MG AND 150 MG AT WEEK 52 IN PATIENTS WITH ANKYLOSING SPONDYLITIS WHO DID NOT ACHIEVE INACTIVE DISEASE DURING AN INITIAL 16 WEEKS OF OPEN-LABEL TREATMENT WITH SECUKINUMAB 150 MG

Background

Ankylosing spondylitis (AS) is a chronic, systemic inflammatory condition characterized by inflammatory back pain and is associated with extra-musculoskeletal manifestations and systemic comorbidities. Secukinumab (SEC) doses of 150 mg and 300 mg are approved to treat AS, although no dose escalation studies are available in patients who have inadequate response to SEC 150 mg.

Objectives

The ASLeap study (NCT03350815) estimated the difference in clinical response to SEC 300 mg vs 150 mg at Week (Wk) 52 in patients with AS who failed to achieve Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease status on SEC 150 mg at Wk 16.

Methods

In this randomized, double-blind, parallel-group, multicenter, phase 4 study, 322 patients with AS were assigned to receive open-label SEC 150 mg administered per the label for 16 Wks (period 1). At Wk 16, patients who did not achieve inactive disease (ASDAS < 1.3) at Wks 12 and 16 were randomized 1:1 in a double-blind manner to SEC 150 mg or escalated to SEC 300 mg q4w to Wk 52 (period 2). The primary efficacy variable was achievement of ASDAS < 1.3 and the primary analysis time point was Wk 52. Secondary efficacy variables were achievement of ASDAS clinically important improvement ≥ 1.1, 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI50), Assessment of SpondyloArthritis international Society responses (ASAS20, ASAS40, and ASAS partial remission), and change from baseline in BASDAI, ASAS Health Index (ASAS-HI), and the Functional Assessment of Chronic Illness Therapy – Fatigue Scale (FACIT-F). Safety was evaluated by incidence of treatment-emergent adverse events (TEAEs) through Wk 52. No statistical hypothesis tests for superiority or equivalence were planned in the protocol and none were performed.

Results

Of 279 patients receiving SEC 150 mg who completed the 16-wk open-label period 1, 22 (7.9%) achieved ASDAS < 1.3 at Wks 12 or 16 and continued receiving SEC 150 mg; 207 patients did not attain ASDAS < 1.3 at Wk 12 and Wk 16 and initiated period 2. Demographics and baseline disease characteristics were balanced between patients randomized to SEC 150 mg and SEC 300 mg, including the proportion of patients who were TNFi naive (SEC 150 mg: 73 [72.3%]; SEC 300 mg: 73 [69.5%]) (Table 1). Approximately 60% of patients in either SEC group were HLA-B27 positive. After having an inadequate response to SEC 150 mg through Wk 16, patients receiving either dose of SEC experienced similar improvements at Wk 52 in disease activity as measured by achievement of ASDAS < 1.3, ASDAS clinically important improvement ≥ 1.1, BASDAI50, ASAS20, ASAS40, and ASAS partial remission; and mean changes in BASDAI, quality of life as measured by ASAS HI, and fatigue as measured by FACIT-F (Figure 1). The incidence of TEAEs through Wk 52 was similar between patients receiving SEC 300 mg (63.4%) and 150 mg (68.6%).

Table 1.

Demographics and Baseline Disease Characteristics of Patients in Period 2 (safety set)

CharacteristicSecukinumab 150 mg → 300 mg N = 101Secukinumab 150 mg → 150 mg N = 105Age, mean (SD), years48.5 (14.1)47.0 (13.7)Female, n (%)43 (42.6)52 (49.5)BMI, mean (SD), kg/m232.0 (8.0)32.1 (7.7)HLA-B27 positive, n (%)60 (59.4)65 (61.9)Time since axial symptom onset, mean (SD), years13.9 (11.7)14.0 (12.5)Time since diagnosis of AS, mean (SD), years4.7 (8.6)5.1 (9.7)TNFi naive, n (%)73 (72.3)73 (69.5)History of extra-axial involvement, n (%)Peripheral arthritis34 (33.7)30 (28.6)Enthesitis29 (28.7)31 (29.5)Uveitis13 (12.9)17 (16.2)Psoriasis14 (13.9)14 (13.3)Dactylitis7 (6.9)4 (3.8)Inflammatory bowel disease2 (2.0)1 (1.0)

AS, ankylosing spondylitis; BMI, body mass index; TNFi, tumor necrosis factor inhibitor.

Conclusion

Patients with AS who did not achieve inactive disease by Wk 16 after receiving SEC 150 mg experienced similar clinical response and safety through Wk 52 regardless of dose escalation to SEC 300 mg or continuation on SEC 150 mg.

Acknowledgements

This study was funded by Novartis Pharmaceuticals Corporation. Medical writing support was provided by Richard Karpowicz, PhD, CMPP, of Health Interactions, Inc, and was funded by Novartis Pharmaceuticals Corporation. This abstract was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.

Disclosure of Interests

Atul Deodhar Consultant of: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB, Alan Kivitz Shareholder of: Amgen, Gilead, GSK, Novartis, Pfizer, and Sanofi, Speakers bureau: AbbVie, Celgene, Flexion, Genzyme, GSK, Eli Lilly, Horizon, Merck, Novartis, Pfizer, Sanofi, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Flexion, Gilead, Janssen, Pfizer, Regeneron, Sanofi, and Sun Pharma, Marina Magrey Consultant of: Eli Lilly and Novartis, Grant/research support from: AbbVie, Amgen, and UCB, Jessica A. Walsh Consultant of: Amgen, Lilly, Novartis, and UCB, Grant/research support from: AbbVie and Pfizer, Philip J Mease Speakers bureau: AbbVie, Amgen, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Galapagos, Gilead, GlaxoSmithKline, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Grant/research support from: AbbVie, Amgen, Bristol Myers Squibb, Celgene, Gilead, Janssen, Eli Lilly, Novartis, Pfizer, Sun Pharma, and UCB, Maria Greenwald Grant/research support from: AbbVie, Eli Lilly, Novartis, Pfizer, Galapagos, and Janssen, Renato Calheiros Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Farid Kianifard Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Chelsea Elam Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Kriti Nagar Employee of: Novartis Healthcare Pvt Ltd, Hyderabad, India, Adam Winseck Employee of: Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, Lianne S. Gensler Consultant of: Galapagos, Eli Lilly, Janssen, and Pfizer, Grant/research support from: UCB Pharma, AbbVie, Amgen, and Novartis.

FRI0271 IMPACT OF HLA-B27 STATUS ON CLINICAL OUTCOMES AMONG PATIENTS WITH ANKYLOSING SPONDYLITIS TREATED WITH SECUKINUMAB

Background:

Ankylosing spondylitis (AS) is strongly associated with the genetic marker HLA-B27. Approximately 80%-90% of white patients with AS express HLA-B27 compared with < 8% of the general population. In patients with AS, negative HLA-B27 status is a predictor of worse response to TNFis.1The impact of HLA-B27 status on clinical efficacy of secukinumab, a fully human monoclonal antibody that selectively inhibits IL-17A, has not been studied.

Objectives:

To analyze the impact of HLA-B27 status on clinical outcomes at Week 16 in patients with AS treated with secukinumab vs placebo.

Methods:

Patients with AS were pooled from the MEASURE 1-4 studies (NCT01358175,NCT01649375,NCT02008916, andNCT02159053) and stratified by HLA-B27 status. All trials included patients who received secukinumab 150 mg every 4 weeks with or without an initial loading dose (10 mg/kg IV at Weeks 0, 2, 4 or 150 mg SC at Weeks 0, 1, 2, and 3) or placebo control. MEASURE 3 included patients receiving secukinumab 300 mg every 4 weeks following the initial IV loading dose. Efficacy at Week 16 was determined by the proportion of patients achieving ASAS20/40, ASAS5/6, ASAS partial remission, BASDAI50, ASDAS-CRP < 2.1, ASDAS-CRP < 1.3, and improvement in Patient Global Assessment (VAS) and total spinal/back pain (VAS) scores. In MEASURE 1, 2, and 4, quality of life (QOL) was assessed at Week 16 by the SF-36 PCS, SF-36 MCS, and ASQOL. ASAS, BASDAI, and ASDAS-CRP responses were analyzed by nonresponder imputation, and all other outcomes by mixed models for repeated measures. For hypothesis generation, outcomes at Week 16 with secukinumab vs placebo within HLA-B27 strata were compared by logistic regression analysis without adjustment for multiple comparisons.

Results:

Baseline characteristics were balanced across treatment groups, although more HLA-B27+ patients than HLA-B27− patients were male (71%-73% vs 43%-50%). HLA-B27+ patients receiving any dose of secukinumab were significantly more likely to achieve ASAS, BASDAI50, and ASDAS-CRP responses vs those receiving placebo (P< .05; Figure 1). HLA-B27− patients receiving secukinumab 300 mg were significantly more likely to achieve ASAS40, ASAS partial remission (Figure 1A), and BASDAI50 (Figure 1B) responses than those receiving placebo (P< .05). Patients receiving any dose of secukinumab were more likely to achieve ASAS5/6 and ASDAS-CRP < 2.1 than those receiving placebo, regardless of HLA-B27 status (P< .05; Figure 1B). All secukinumab-treated patients experienced significant improvement in Patient Global Assessment at Week 16 vs placebo, regardless of HLA-B27 status, while only HLA-B27+ patients experienced significant reduction in total spinal/back pain vs placebo (P< .05; Figure 2A). Numerical improvements in QOL were observed in all patients receiving secukinumab 150 mg vs placebo; these reached significance for HLA-B27+ patients (Figure 2B).

Conclusion:

Secukinumab is effective in patients with AS regardless of HLA-B27 status; HLA-B27+ patients may derive increased therapeutic benefit compared with HLA-B27− patients.

Reference:

[1]Alazmi M, et al.Arthritis Care Res (Hoboken). 2018;70:1393-9.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation. The authors thank Rich Karpowicz, PhD, of Health Interactions, Inc, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Denis Poddubnyy Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Consultant of: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB, Renato Calheiros Shareholder of: Novartis, Employee of: Novartis, Xiangyi Meng Shareholder of: Novartis, Employee of: Novartis, Vibeke Strand Consultant of: AbbVie, Amgen, Biogen, Celltrion, Consortium of Rheumatology Researchers of North America, Crescendo Bioscience, Eli Lilly, Genentech/Roche, GlaxoSmithKline, Hospira, Janssen, Merck, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi, UCB, Marina Magrey Grant/research support from: AbbVie, Amgen, and UCB, Consultant of: Eli Lilly and Novartis

THU0397 SYMPTOMS OF PERIPHERAL ARTHRITIS ARE SIGNIFICANTLY IMPROVED IN PATIENTS WITH ANKYLOSING SPONDYLITIS TREATED WITH SECUKINUMAB

Background:

Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton associated with pain, stiffness, and disability.1Up to 66% of patients (pts) with AS may also have peripheral involvement, including swollen and tender joints (STJs),2,3which are associated with worse overall disease activity.4A previous analysis showed that secukinumab, a selective inhibitor of interleukin 17A, led to significant improvements in efficacy outcomes vs placebo, regardless of peripheral joint involvement.3However, the effect of secukinumab on symptoms of peripheral arthritis in pts with AS was not assessed.

Objectives:

The objective of this analysis was to assess changes in peripheral symptoms in pts with AS treated with secukinumab vs placebo.

Methods:

Data from pts with active AS and peripheral symptoms who were enrolled in MEASURE 1 (NCT01358175), 2 (NCT01649375), 3 (NCT02008916), and 4 (NCT02159053) were pooled in this post hoc, hypothesis-generating analysis. No adjustments for multiple comparisons were made. Pts with peripheral symptoms were identified by the presence of STJs, based on 44-joint counts at baseline (BL). Pts received subcutaneous (SC) secukinumab every 4 weeks at doses of 300 mg with an intravenous (IV) loading dose (MEASURE 3 only), 150 mg with an IV or SC loading dose, or placebo. Treatment response through Week 16 was assessed based on the proportions of pts who achieved improvements of 20%, 50%, 70%, or 100% in the number of swollen and number of tender joints and improvements in the BASDAI score for question 3 and Patient Global Assessment (PGA). Changes in the number of swollen and number of tender joints were assessed in pts with swollen or tender joints at BL, respectively.

Results:

This pooled analysis included 560 pts with AS and STJs at BL (Table). At Week 16, treatment with secukinumab led to significantly greater proportions of pts achieving reductions in the number of swollen (Fig 1A) or tender (Fig 1B) joints compared with placebo; the treatment effect was more pronounced in reduction of swollen joints. Furthermore, a greater proportion of secukinumab-treated pts achieved complete resolution of swollen or tender joints vs placebo (Fig 1). Secukinumab also led to significant improvements in peripheral pain/swelling (Fig 2A) and disease activity (Fig 2B) vs placebo, as assessed using BASDAI question 3 and the PGA, respectively.

Table.

Patient Characteristics at Baseline

SecukinumabPlacebo (n = 252)300 mg (n = 52)150 mg (n = 256)Age, mean, y43.643.744.9Time since diagnosis, mean, y5.67.27.3Male, %63.562.157.5PGA of Disease Activity, mean, mm73.471.770.1BASDAI question 3, mean6.36.66.4Swollen 44-joint count, mean1.92.62.5Tender 44-joint count, mean7.17.87.9

Conclusion:

In parallel with its previously reported efficacy in axial symptoms,3secukinumab led to significant improvements in symptoms of peripheral arthritis in pts with AS. Significant improvements were seen in both tender and swollen joints.

References:

[1]Braun J, Sieper J.Lancet. 2007;369:1379-1390.

[2]de Winter JJ, et al.Arthritis Res Ther. 2016;18:196.

[3]Mease P, et al.Arthritis Rheumatol. 2019;71(suppl 10):1553.

[4]de Winter JJ, et al.RMD Open. 2019;5:e000802.

Acknowledgments:

This study was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ. The authors thank Amos Race, PhD, of ArticulateScience LLC, Hamilton, NJ, USA, for providing medical writing/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Philip J Mease Grant/research support from: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – grant/research support, Consultant of: Abbott, Amgen, Biogen Idec, BMS, Celgene Corporation, Eli Lilly, Novartis, Pfizer, Sun Pharmaceutical, UCB – consultant, Speakers bureau: Abbott, Amgen, Biogen Idec, BMS, Eli Lilly, Genentech, Janssen, Pfizer, UCB – speakers bureau, Atul Deodhar Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Bristol Myer Squibb (BMS), Eli Lilly, GSK, Janssen, Novartis, Pfizer, UCB, Renato Calheiros Shareholder of: Novartis, Employee of: Novartis, Xiangyi Meng Shareholder of: Novartis, Employee of: Novartis, Todd Fox Shareholder of: Novartis, Employee of: Novartis, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen