Predictors of secukinumab treatment response and continuation in axial spondyloarthritis: results from the EuroSpA research collaboration network

Abstract
Objective In patients with axial spondyloarthritis (axSpA) initiating secukinumab, we aimed to identify baseline (treatment start) predictors of achieving low disease activity (LDA) after 6 months, as measured by Axial Spondyloarthritis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), as well as treatment continuation after 12 months.
Methods From 11 European registries, patients with axSpA, who initiated secukinumab treatment in routine care, with available data on 6-month ASDAS and BASDAI assessments were included. Logistic regression analyses on multiply imputed baseline data were performed; potential baseline predictors included demographic, diagnosis, lifestyle, clinical and patient-reported variables.
Results In a pooled cohort of 1,174 patients with axSpA, 5 of 19 potential assessed variables were mutually predictive for achieving LDA by ASDAS-CRP and BASDAI: higher Physician Global Assessment score, non-current smoking, lack of prior exposure to biologic/targeted synthetic Disease-Modifying Anti-Rheumatic Drugs, lower Health Assessment Questionnaire scores and BASDAI scores. Moreover, radiographic axSpA and CRP ≤ 10mg/L were associated with achieving ASDAS-CRP LDA; HLA-B27 positivity and history of psoriasis with achieving BASDAI LDA; while earlier time of secukinumab initiation (2015-2017) was associated with treatment continuation.
Conclusion In this European real-world study of patients with axSpA initiating secukinumab, predictors of achieving LDA by ASDAS-CRP and BASDAI at 6 months and remaining on treatment at 12 months included both clinical, patient-reported and lifestyle factors, underscoring the complex mechanisms of real-world drug effectiveness.