Disease Modification with IL-17 Inhibition

Patient MH, 30/M, presents with a 13-year history of ankylosing spondylitis (AS) with bamboo spine, previously managed with non-steroidal anti-inflammatory drugs (NSAIDs), Sulfasalazine, Adalimumab, and Golimumab, but still with flaring of symptoms – should we continue with tumor necrosis factor (TNF) inhibitors or switch to a different medication?

This was the case presented by Prof. James Wei, Professor of the Institute of Medicine, Division of Immunology and Rheumatology, at the Chung Shan Medical University Hospital, Taichung, Taiwan, during the Philippine Rheumatologic Association (PRA) Annual Convention on 01 March 2024.

AS is just part of the spectrum of spondyloarthritis (SpA) diseases, which includes psoriatic arthritis, reactive arthritis, and other conditions (Fig. 1). Current treatment options include NSAIDs, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), and novel immune-targeted therapies such as interleukin inhibitors.¹

Spectrum of SpA

Of the interleukins, interleukin-17 (IL-17) has been identified as a key cytokine in the pathogenesis of AS. IL-17 inhibitors are approved for the management of psoriasis, psoriatic arthritis, and AS. They are primarily involved in host defenses, tissue repair, and inflammatory diseases.¹

Secukinumab is an IL-17 inhibitor extensively studied in the management of AS. In the MEASURE 1 and MEASURE 2 studies, administration of Secukinumab 150 mg led to significant improvements in the Ankylosing Spondylitis Disease Activity Score (ASAS) 20 and ASAS 40 response versus placebo as early as in week 1 after treatment.³ This was supported by a study among the Asian population wherein there were more Asian patients achieving ASAS 20 and ASAS 40 response versus the overall population.⁴ Furthermore, in the SURPASS study, majority of patients showed no radiographic progression when treated with Secukinumab.⁵

Overall, several clinical studies demonstrated that Secukinumab has a comparable efficacy with TNF inhibitors in the management of axial and peripheral arthritis, enthesitis, dactylitis, as well as preventing radiographic progression of the disease. Better efficacy in plaque psoriasis has been observed. Moreover, there were no risks seen in patients with tuberculosis.¹

The primary goal in the management of SpA is to maximize health-related quality of life. According to the 2022 Assessment of Spondyloarthritis International Society and European Alliance of Associations for Rheumatology (ASAS-EULAR) Recommendations, education, exercise, physical therapy, rehabilitation, patient associations, and self-help groups will support holistic management. In terms of pharmacologic treatment, following a first biologic DMARD failure, switching to another biologic DMARD (TNF or IL-17 inhibitor) or a janus kinase (JAK) inhibitor should be considered (Fig. 2). A personalized approach in the management of patients with SpA, based on individual need and supported by scientific evidence and shared decision-making, should be done.⁶

2022 ASAS-EULAR Recommendations for SpA

Going back to our case, patient was started with Secukinumab. Clinical improvements were seen as early as within the first week of treatment. C-reactive protein (CRP) levels decreased from 3 to 0.3. There were no adverse events that occurred. More importantly, quality of life has been significantly improved.¹

This shows that Secukinumab, through disease modification with IL-17 inhibition, is a potent option for the management of patients with AS.¹

For more information on Secukinumab (Scapho®), read the full prescribing information here.

1. Wei. (2024). Radiographic and Clinical Evidence of Disease Modification with IL-17 Inhibition. Presented during the PRA Annual Convention on 01 March 2024.
2. Wei at al. (2013). Chronic Inflammation: Causes, Treatment Options, and Role in Disease.  Nova Science Publishers, Inc.
3. Baeten et al. (2015). Secukinumab, an Interleukin-17A Inhibitor, in Ankylosing Spondylitis. New England Journal of Medicine. 373:2534-2548.
4. Wei et al. (2017). Efficacy and Safety of Secukinumab in Asian Patients with Active Ankylosing Spondylitis: 52-Week Pooled Results From Two Phase 3 Studies. International Journal of Rheumatic Diseases. 20(5):589-596.
5. Baraliakos et al. (2022). Effect of Secukinumab versus Adalimumab Biosimilar on Radiographic Progression in Patients with Radiographic Axial Spondyloarthritis: A Randomized Phase IIIb Study. Presented during the ACR Convergence 2022.
6. Ramiro et al. (2023). ASAS-EULAR Recommendations for the Management of Axial Spondyloarthritis: 2022 Update. Annals of the Rheumatic Diseases. 82(1):19-34.