Ab0962 comparison between secukinumab and ixekizumab in psoriatic arthritis and axial spondyloarthritis: a single center experience

Background The pathogenesis of SpA has not been completely elucidated, but several pieces of evidence suggest that interleukin (IL)17-A plays a pivotal role in this group of diseases. Both anti-IL-17A drugs Secukinumab (SEC) and Ixekizumab (IXE) have shown efficacy in treating multiple facets of SpA. (2) Objectives Our study aimed to compare the effect of SEC and IXE in our cohort of patients with PsA or axSpA. Methods We retrospective analyzed our clinical database, enrolling patients with PsA or axSpA treated with SEC or IXE. We collected disease activity scales and scores at baseline (0) and after 3, 6 and 12 months of treatment: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), DAPSA (Disease Activity Index for Psoriatic Arthritis), VAS (Visual Analog Scale) for pain, PGA (Patient Global Assessment), and PHGA (Physician Global Assessment). Results We selected 73 patients, 55 with PsA (75.30%) and 18 with axSpA (24.70%). In the SEC cohort, we found 52 patients, mainly females (73.00%), mean age of 57.00 ± 11.47 years; in the IXE cohort, there were 21 patients, 71.43% females, mean age of 53.81 ±11.17 years. Peripheral involvement was present in the majority of patients (88.46% vs. 100%), while axial involvement was predominant in SEC treated patients (61.54% vs. 28.57%). The presence of dactylitis was similar in the two groups (15.38% vs. 14.29%), enthesitis prevailed in SEC cohort (75.00% vs. 57.14%) while cutaneous psoriasis in the IXE cohort (44.23% vs. 80.95%). During follow-up, BASDAI and DAPSA decreased significantly in both SEC and IXE groups, especially in the first trimester, with a similar trend during the second trimester (significant only for SEC). When compared with each other, SEC and IXE appeared to have a similar effect on both scales, except for a significantly greater reduction of BASDAI in the first trimester for SEC, which however was no longer present when the values were adjusted for the starting BASDAI value (Table 1). Analyzing PGA, PHGA, and VAS pain, we observed a significant trend in reduction in the first trimester for both drugs, then maintained only for SEC, significantly greater for SEC than IXE in both trimesters. The analysis of the adjusted values confirmed the significant decrease in BASDAI DAPSA PGA PHGA and VAS for both SEC and IXE, especially until 6 months after baseline. Conclusion Our data confirmed that SEC and IXE are both valid options for the treatment of PsA and axSpA, without significant differences when comparing the two drugs. References [1]Dougados M. et al, “Spondyloarthritis”, Lancet. 2011 Jun 18; DOI: 10.1016/S0140-6736(11)60071-8 [2]McGonagle DG. et al, “The role of IL-17A in axial spondyloarthritis and psoriatic arthritis: recent advances and controversies”. Ann Rheum Dis. 2019 DOI: 10.1136/annrheumdis-2019-215356 Table 1. BASDAI and DAPSA variations between SEC and IXE during follow up Month Drug Change Change difference Change adj Change difference adj Estimate (CI95%) P Estimate (CI95%) p Estimate (CI95%) p Estimate (CI95%) p BASDAI 0 vs 3 SEC -1.20 (-1.64 - -0.76) <.0001 0.73 (0.13 – 1.33) 0.0174 -0.81 (-1.21 - -0.41) <.0001 0.20 (-0.37 - 0.77) 0.4894 IXE -0.47 (-0.88 - -0.06) 0.0256 -0.61 (-0.99 - -0.22) 0.0019 3 vs 6 SEC -0.71 (-1.21 - -0.21) 0.0048 0.41 (-0.16 – 0.99) 0.1620 -0.75 (-1.19 - -0.30) 0.0009 0.12 (-0.47 – 0.72) 0.6819 IXE -0.30 (-0.60 - 0.002) 0.0519 -0.62 (-1.01 - -0.25) 0.0012 6 vs 12 SEC -0.43 (-0.82 - -0.04) 0.0287 0.53 (-0.18 – 1.24) 0.1452 -0.76 (-1.28 - -0.23) 0.0044 0.43 (-0.32 – 1.18) 0.2609 IXE 0.01 (-0.50 – 0.70) 0.7458 -0.33 (-1.01 – 0.34) 0.3392 DAPSA 0 vs 3 SEC -7.11 (-8.51 - -5.71) <.0001 0.87 (-3.59 – 5.34) 0.7002 -4.27 (-5.85 - -2.69) <.0001 0.95 (-1.87 – 3.78) 0.5087 IXE -6.23 (-10.47 - -1.99) 0.0040 -3.32 (-5.42 - -1.21) 0.0020 3 vs 6 SEC -1.51 (-2.93 - -0.08) 0.0374 -0.95 (-3.82 – 1.91) 0.5160 -2.79 (-4.61 – 0.96) 0.0027 -0.35 (-2.77 – 2.07) 0.7776 IXE -2.46 (-4.95 – 0.03) 0.0529 -3.14 (-5.07 - -1.21) 0.0014 6 vs 12 SEC -0.11 (-1.77 – 1.54) 0.8918 2.45 (-3.79 – 8.69) 0.4422 -2.84 (-5.05 – 0.63) 0.0116 2.67 (-3.70 – 9.05) 0.4107 IXE 2.33 (-3.68 – 8.35) 0.4475 -0.16 (-6.72 – 6.38) 0.9596 Acknowledgements: NIL. Disclosure of Interests None Declared.