Friday, 28 Feb 2020

You are here

IL-17 Inhibitors In Non-Radiographic Axial SpA

This meeting sees new data on using anti-IL-17 agents in non-radiographic axial SpA. Up until now these patients have only had TNF inhibitors available, so data about the efficacy of IL17 inhibitors is really important.

We get to see new secukinumab (Late breaking abstract 21) 16 week data of their 555 patient trial with loading & no loading of 150mg of secukinumab versus placebo (1:1:1). Inclusion criteria are very important in this disease, as previous trials have been substantially affected by inclusion criteria, think poor response of adalimumab in ABILITY-1. Included patients had to meet the ASAS criteria and have an abnormal CRP or MRI. The primary endpoint was ASAS40 in TNF naïve patients at 16 weeks. Importantly 89-90% of patients were TNF inhibitor naïve and they had had their back pain for greater than 8 years. At week 16 42% of secukinumab patients met the primary endpoint versus 29% in the placebo group. Safety was consistent with previous secukinumab trials. 

We also get to see the ixekizumab (Plenary Session III, abstract 2729) 52 week data. Again, patients had to meet the ASAS criteria and also have an abnormal CRP or MRI and have an inadequate response to NSAIDs. Patients had had greater than 10 years of symptoms and a mean of 3-4 years since diagnosis. Patients were randomised (1:1:1) to placebo, 80mg every 2 weeks or 80mg every 4 weeks. The primary endpoint was ASAS40 at week 16 and week 52. At 16 weeks in the ITT population ASAS40 was 20%:34%:41% in placebo:Q4W:Q2W, and then at week 52 the ITT population ASAS40 was 14%:29%:32% in placebo:Q4W:Q2W.

It is very clear that the devil is in the detail when thinking about nr-axSpA and treatment response and the details that are important are CRP and MRI positivity, disease duration and previous biologic use. In nr-axSpA we have seen trials that have patients with short disease duration, a high proportion of positive CRP and MRI (or both even) and minimal previous biologic use have shown the best response. Therefore, comparisons between trials of different agents is much more challenging to try to get an idea of comparable efficacy. The take home is that anti-IL17 agents are effective in this condition but picking your patients carefully is likely to see a greater proportion responding favourably.

Add new comment

More Like This

No Cancer Increase in Psoriatic Arthritis or with Biologics in Psoriasis

JAMA Dermatology reports that psoriasis is associated with a slightly increased risk of cancer, particularly keratinocyte cancer and lymphomas.

A systematic review and meta-analysis of 112 studies including more than 2 million patients, also shows no increase in when psoriasis is treated with biologic agents, nor was psoriatic arthritis associated with an increased risk of cancer.   

Bimekizumab Effective in Active Psoriatic Arthritis

Interleukin 17 IIL-17) is important in the pathogenesis of psoriatic disease, with most current approaches targeting IL-17A. Now there is a noveal approach showing that dual neutralisation of IL-17A and IL-17F in psoriatic arthritis arthritis patients results in clinically significant improvement.

Upadacitinib Effective in Phase 3 Psoriatic Arthritis Study

Abbvie has announced top line results of their SELECT-PSA trial of upadacitinib (UPA), wherein both the 15 and 30 mg doses met the primary endpoint of ACR20 response at week 12 and demonstrated radiographic inhibition at week 24.

Which Biologics are Best in Psoriasis

A metanalysis of phase II, III and IV trials in moderate to severe plaque psoriasis suggests comparative efficacy biologic treatments, but that that brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa were shown to have the past skin (PASI) response rates.

Taltz Shines in Non-Radiographic Axial Spondyloarthritis

Ixekizumab (IXE), an interleukin-17A (IL-17A) inhibitor, was recently approved for use in ankylosing spondylitis (also known as radiographic axial spondyloarthritis- axSpA). Lancet has published the results of the COAST-X study showing that ixekizumab was effective in patients with non-radiographic axial spondyloarthritis.