Secukinumab safe, effective for Behçet's phenotype resistant to conventional treatment
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Secukinumab was safe and effective for Behçet’s syndrome among patients with a mucosal and articular phenotype refractory to previous conventional and biologic treatments, according to data published in the Annals of the Rheumatic Diseases.
“Intriguingly, oral and genital ulcerations and peripheral arthritis are the dominant clinical manifestations of the ‘mucosal and articular’ phenotype of BS,” Filippo Fagni, PhD, MSc, of the University of Florence, in Italy, and colleagues wrote. “At the same time, evidence of an increased prevalence of peripheral SpA-like features such as enthesopathy has also been reported in this subset of patients, while axial involvement is inconstant. The unique attributes of the mucosal and articular phenotype thus strongly hint at a potential utility for anti-IL-17 drugs.”
To analyze the efficacy and safety of secukinumab (Cosentyx, Novartis) among patients with a mucosal and articular Behçet’s phenotype resistant to conventional and biologic treatment, Fagni and colleagues conducted a multicenter retrospective, observational study. The study comprised 15 patients with Behçet’s syndrome with active mucosal and articular phenotype, treated with secukinumab between November 2016 and November 2019 at one of four referral centers in Italy and Australia. All participants had been confirmed refractory to treatment with colchicine, DMARDs and at least one TNF alpha inhibitor.
Six patients with a polyarticular involvement received secukinumab doses of 300mg per month, while all other participants received 150mg per month. Increases from 150mg to 300mg each month and shortening of administration frequency were allowed for patients who demonstrated poor disease control. The minimum follow-up period was 6 months. Researchers based treatment response on the number of oral ulcers in the previous 28 days and Disease Activity Score-28 for articular manifestations.
According to the researchers, 66.7% of participants achieved a complete or partial response at 3 months. This figure later increased to 86.7% at 6 months, then to 76.9% at 12 months, 90% at 18 months, and ultimately 100% after 24 months. All participants who started with doses of 300mg per month achieved complete response by month 6. Among those who started with 150 mg per month, 46.7% were able to achieve a response only after switching to the higher dose.
“Our study suggests that the anti-IL-17 agent secukinumab is a safe and effective therapy for patients with BS with a mucosal and articular phenotype even when refractory to previous treatments, as it acts on both manifestations concomitantly,” Fagni and colleagues wrote. “Secukinumab 300mg/month showed superior effectiveness in inducing complete remission in all patients, including those who did not show satisfactory response to the 150mg/month dosage.”
“These data are in line with the idea that specific phenotypes of BS may benefit from tailored therapeutic approaches,” they added. “Moreover, data on the effects of secukinumab in single disease manifestations are also encouraging.”
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