Short-Term Efficacy and Safety of Secukinumab for Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of RCTs.

Yu Zhou,Jinhui Ma,Weiguo Wang,Debo Yue,Bailiang Wang,Juncheng Ge,Qingdong Guan

doi:10.1155/2020/1639016

Yu Zhou, Jinhui Ma + Show 5 more

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https://doi.org/10.1155/2020/1639016

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Abstract

Secukinumab is a novel IL-17A inhibitor that has been confirmed to be effective for treating PsA and RA. Several studies have demonstrated that secukinumab also provides benefits for AS patients. Thus, we performed a meta-analysis of RCTs to evaluate the short-term efficacy and safety of secukinumab for the management of AS. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for RCTs published prior to March 2020 on the treatment of AS with secukinumab. The primary outcome was the ASAS20 response, and the secondary outcomes included the ASAS40 response, ASAS5/6 response, SF-36 PCS score, ASQoL score, and AEs. Dichotomous data were expressed as pooled RRs with 95% CIs, while continuous data were expressed as pooled MDs with 95% CIs. Subgroup analysis was conducted based on whether the AS patients previously underwent treatment with TNFi. A total of 4 RCTs with 1166 patients were included in our meta-analysis. At week 16, secukinumab 150 mg yielded significant improvements in the clinical response and patient-reported outcomes for AS patients. There was no increased risk of AEs. Consistent results were detected in the meta-analysis of secukinumab 75 mg versus a placebo. Furthermore, no significant difference was detected between the secukinumab 75 mg group and secukinumab 150 mg group. We concluded that secukinumab is effective for treating AS and generally well tolerated by AS patients in the short term, regardless of whether they previously underwent TNFi treatment. The superiority of secukinumab 150 mg over secukinumab 75 mg seems to be limited, since no significant difference in any endpoint was detected between the two groups.

Highlights

Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory disease and a subtype of radiographic axial spondyloarthritis [1]
The full texts of the remaining 18 articles were retrieved for further assessment, and 13 articles were eliminated for the following reasons: the study was not an randomized controlled trials (RCTs), there was no placebo group, the study did not meet the inclusion criteria for outcomes, or it was a duplicate of a previous publication
Four RCTs with 777 patients in the secukinumab 150 mg arm and placebo arm reported the ASAS20, ASAS40, and ASAS5/6 response rates at week 16, and the estimated risk ratios (RRs) were 1.71, 2.16, and 2.87, respectively (Figure 3)

Summary

Introduction

Ankylosing spondylitis (AS) is a chronic autoimmune inflammatory disease and a subtype of radiographic axial spondyloarthritis [1]. Previous studies have demonstrated that AS patients exhibit increased IL-17 and IL-23 levels in the serum and synovial fluid [8, 9]. This imbalance of the IL-17/IL-23 axis may lead to uncontrolled inflammation, joint destruction, and excessive bone formation, which can promote the progression of the disease [4, 10, 11]. The blockage of IL-17 has been proved to reduce cartilage destruction and bone erosion in collagen-induced arthritis models, which suggests that IL-17 should potentially be a target for the management of AS [12, 13].

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