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One-year treatment outcomes of secukinumab versus tumor necrosis factor inhibitors in Spondyloarthritis


Arthritis Care Res (Hoboken). 2020 Nov 30. doi: 10.1002/acr.24523. Online ahead of print.

Bente Glintborg 1 2Ulf Lindstrom 3Daniela Di Giuseppe 4Sella Aarrestad Provan 5Bjorn Gudbjornsson 6Merete Lund Hetland 1 2Brigitte Michelsen 7 8Johan Wallman 9Kalle Aaltonen 10Anna-Mari Hokkanen 11Dan Nordström 12Tanja Schjødt Jørgensen 13Rebekka Lund Hansen 13Arni Jon Geirsson 14Kathrine Grøn 1Niels Steen Krogh 15Johan Askling 4Lars Erik Kristensen 13Lennart Jacobsson 3DANBIO (Denmark), ARTIS/SRQ (Sweden), ICEBIO (Iceland), ROB-FIN (Finland), NOR-DMARD (Norway) registries

Author Information

1 DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.

2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

3 Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.

4 Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

5 Diakonhjemmet Hospital, Oslo, Norway.

6 Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Iceland.

7 Department of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.

8 Division of Rheumatology, Department of Medicine, Sørlandet Sykehus, Kristiansand, Norway.

9 Clinical Sciences Lund, Rheumatology, Lund University, Skane University Hospital, Lund, Sweden.

10 Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland.

11 Department of Medicine, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

12 Department of Medicine and Rheumatology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

13 The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.

14 Department of Rheumatology, University Hospital, Reykjavík, Iceland.

15 CEO, Zitelab, Copenhagen, Denmark.


Objective: To describe baseline characteristics and to compare treatment effectiveness of secukinumab versus tumor necrosis factor inhibitors (TNFi), in patients with spondyloarthritis (SpA) using adalimumab as the main comparator.

Methods: Observational, prospective cohort study. Patients with SpA (clinical ankylosing spondylitis/non-radiographic axial SpA/undifferentiated SpA) starting secukinumab or a TNFi during 2015-2018 were identified from five Nordic clinical rheumatology registries. Comorbidities and extra-articular manifestations (psoriasis/uveitis/inflammatory bowel disease) were captured from national registries (data available in 94% of patients) and included in multivariable analyses. We assessed 1-year treatment retention (crude survival curves, adjusted hazard ratios (HR) for treatment discontinuation) and 6-months' response-rates (ASDAS<2.1/BASDAI<40mm, crude/LUNDEX-adjusted, adjusted logistic-regression analyses with odds-ratio(OR)), stratified by line of biological treatment (1st /2nd /3rd +).

Results: In total, 10,853 treatment courses (842 secukinumab/10,011 TNFi whereof 1,977 adalimumab) were included. The proportion treated with secukinumab during 1st /2nd /3rd + was 1%/6%/22%). Extra-articular manifestations varied across treatments, while other baseline characteristics were largely similar. Secukinumab had a one-year retention comparable to adalimumab as 1st or 2nd , but poorer as 3rd + line of therapy (secukinumab 56% (51%-61%) versus adalimumab 70% (64%-75%)), adjusted HR 1.43 (1.12-1.81). Across treatment lines, secukinumab had poorer estimates for 6-months response rates than adalimumab, statistically significantly so only for 3rd + line (adjusted analyses: ASDAS<2.1 OR=0.56 (0.35-0.90), BASDAI<40mm OR=0.62 (0.41-0.95)). Treatment outcomes varied across the five TNFi.

Conclusion: Secukinumab was mainly used in biologically experienced SpA patients. Secukinumab and adalimumab performed similar in patients who had failed a first biological, although with increasing prior biological exposure, adalimumab was superior.