IL-17 inhibitors offer promising 'effective' treatment for ankylosing spondylitis
Click Here to Manage Email Alerts
IL-17 inhibitors have recently demonstrated “quite effective” results in treating ankylosing spondylitis, according to a speaker at the 2020 Congress of Clinical Rheumatology-East.
“NSAIDs work in about 50% of patients, TNF inhibitors is very good, and IL-17 is going to be quite effective,” said Daniel E. Furst, MD, of the University of Washington, in Seattle, and UCLA, told virtual conference attendees. “The JAK inhibitors might be, and there is hope for Wnt inhibitors as well.”
According to Furst, a 2019 review of five multicenter phase 3 trials, including four randomized, double-blind trials, examining the IL-17A inhibitor secukinumab (Cosentyx, Novartis) in ankylosing spondylitis found the drug effective for patients who were TNF inhibitor-naïve.
This review, published in Drugs, detailed the MEASURE 1-4 trials and noted that patients who received the higher dose of secukinumab — 150 mg weekly for 3 weeks, and then once every 4 weeks — achieved an ASAS20 response 62% of the time, compared with 31% in the placebo group. Patients who received 75 mg of secukinumab achieved the ASAS20 response 50% of the time.
“That is a difference,” Furst said. “So, it looks very specifically that this anti-IL-17A was effective.”
The same trials also demonstrated that only 2% of patients in the placebo group achieved partial remission. Meanwhile, 14% of patients in both secukinumab dosage groups saw partial remission.
However, there were some risks, Furst added. The secukinumab groups together experienced a neutropenia rate of 0.7 per 100 patient-years, as well as an infection rate of 30% compared with 12% among those who received a placebo. The rates of inflammatory bowel disease and major adverse cardiovascular events among the secukinumab groups were both 0.7 per 100 patient-years, while the rate of uveitis was 1.4.
Another study noted by Furst, Yin and colleagues published in Arthritis Research & Therapy this year, found that although treatment-emergent adverse events rose in patients treated with secukinumab, death and serious adverse events were not among them.
Meanwhile, Maksymowych and colleagues published in The European Journal of Rheumatology in 2018, demonstrated that secukinumab equals adalimumab (Humira, AbbVie) over a period of 12 weeks, and could potentially be more beneficial than adalimumab at 24 to 52 weeks.
“What do I take from this?” Furst said. “Well, that secukinumab — IL-17s — and TNF inhibitors, at least these two, are about equivalent over the short-term, and there is a chance that the IL-17s may be effective over the long-term.”
Collapse
Furst D. Spondyloarthritis: Update in Pathogenesis and Therapy. Presented at: Congress of Clinical Rheumatology-East annual symposium; September 10-13, 2020 (virtual meeting).
Read more about
Click Here to Manage Email Alerts