Third-line secukinumab tied to reduced survival in axSpA, axPsA

A real-word study in Argentina has found poor access to secukinumab treatment among patients with public health insurance than those using the social security system or private health coverage. Furthermore, use of secukinumab as third-line therapy or higher is associated with less survival.

Overall, 117 patients with axial spondyloarthritis (axSpA; n=45, 38.5 percent) or psoriatic arthritis (axPsA; n=72, 61.5 percent) aged ≥18 years who received one or more dose of secukinumab were included in this multicentre, observational, retrospective study.

The investigators calculated the number of days between the request for the drug and the first application and analysed drug survival using Kaplan-Meier curves and Cox regression analysis. Effectiveness was defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <4 at 6 months.

Patients with public health insurance had a longer delay in receiving secukinumab (median 90 days) than those using the social security system (p=0.01) and those with private health coverage (p=0.009). [J Rheumatol 2025;52:829-837]

Of the patients, 72 (61.5 percent) achieved successful treatment with secukinumab after 6 months: 44/72 patients with axPsA (61.5 percent) and 28/45 with axSpA (62.2 percent; p=0.91). The median secukinumab survival was 48 months (95 percent CI, 32–63). Secukinumab in the third-line or higher setting correlated with reduced survival (hazard ratio [HR], 3.43, 95 percent CI, 1.11–11.10; p=0.04).

In terms of safety, adverse events (AEs) occurred at a rate of 7.9 per 100 patient-years (95 percent CI, 5–12). Most AEs were mild, and none were of significant interest.

Drug survival

“Survival data similar to our study have been reported,” the investigators said. “Of note is the recently published study by Weddell and coworkers from Leeds, UK, where they evaluated 228 patients (91 with axSpA and 137 with PsA) exposed to IL-17Ai.” 

In the said study, survival rates at 12 and 24 months were 69 percent (95 percent CI, 63–75) and 60 percent (95 percent CI, 54–67), respectively. Similar to the results of the current study, there was no significant difference seen in the median survival between the two diseases (log-rank p=0.65). [Rheumatol Adv Pract 2024;8:rkae018]

“As our current study shows, the line of treatment appears to be an important factor in drug survival,” the investigators said. 

A study by Christiansen and colleagues showed a numerically lower secukinumab retention rate in patients with axSpA at 6, 12, and 24 months than those with axPsA. However, no statistically significant differences were seen between groups (adjusted HR at 24 months, 0.92, 95 percent CI, 0.84–1.02). [Semin Arthritis Rheum 2024;65:152388]

Moreover, patients who had prior exposure to 1 b/tsDMARD and ≥2 b/tsDMARDs had significantly lower retention rates than naive patients in both axSpA and axPsA, respectively. [Semin Arthritis Rheum 2024;65:152388]

“AxSpA and axPsA are chronic diseases characterized by inflammation and damage of the sacroiliac joints and spine that cause pain, disability, reduced quality of life, and loss of work productivity,” according to the investigators.” [Ann Rheum Dis 2024;83:547-549; Rheumatol Ther 2024;11:1441-1456]