Wednesday, September 18, 2013

Ankylosing spondylitis and Secukinumab

There’s a new (?) study on secukinumab in ankylosing spondylitis in The Lancet. I’ve seen similar, but not identical publications on secukinumab during the past year. I think we get to know different details on one ongoing study. I think that secukinumab isn’t working in rheumatoid arthritis, but it might work in psoriatic arthritis and ankylosing spondylitis (AS). So I think it’s a good idea to get ongoing information.
D. Baeten and colleagues published: “Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebo-controlled trial”. The study looked at i.v.  secukinumab (2×10 mg/kg) compared to placebo. Results showed: “At week 6, ASAS20 response estimates were 59% on secukinumab versus 24% on placebo (99·8% probability that secukinumab is superior to placebo). One serious adverse event (subcutaneous abscess caused by Staphylococcus aureus) occurred in the secukinumab-treated group.” Conclusion: “Secukinumab rapidly reduced clinical or biological signs of active ankylosing spondylitis and was well tolerated.” The drug needs to perform better than ASAS20 in larger studies!
X. Baraliakos and colleagues presented a poster at the 2012 ACR Meeting [574]: “Long Term Inhibition of Interleukin (IL)-17A with Secukinumab Improves Clinical Symptoms and Reduces Spinal Inflammation As Assessed by Magnetic Resonance Imaging in Patients with Ankylosing Spondylitis.” Conclusion: “This exploratory MRI analysis shows that the IL-17 inhibitor secukinumab may reduce spinal inflammation and this effect may be sustained for up to 24 months using a lower dose in the maintenance compared to induction phase.”

Do these results warrant a phase 2 study? By all means – yes! Please go ahead! We have patients suffering from ankylosing spondylitis, who are in desperate need for another mode of action, as TNF-alpha inhibition isn’t working. So, an IL-17A inhibitor would be most welcome. 

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