Tumay Ak1, Leyla Mustafayeva2, Ali Yagiz Ayla3, Yeliz Celik3, Gunay Can4, Serdal Ugurlu3

1Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
2Department of Physical Therapy and Rehabilitation, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
3Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
4Department of Public Health, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye

Keywords: Adverse effects, anti-IL-17, anti-TNFα, psoriatic arthritis, secukinumab.


Objectives: This study compared the secukinumab treatment responses and adverse effects in psoriatic arthritis patients who received secukinumab as second-line with those that received secukinumab after two or more tumor necrosis factor-alpha (TNF-α) inhibitors.

Patients and methods: The retrospective study included 68 psoriatic arthritis patients followed up between October 2018 and October 2021. The patients were divided into two groups according to their anti-TNF-α treatment history. Group 1 consisted of 29 patients (11 males, 18 females; mean age: 45.3±13.3 years; range, 21 to 69 years) who had previously received one anti-TNF-α agent, while Group 2 included 39 patients (18 males, 21 females; mean age: 46.4±13.0 years; range, 24 to 70 years) who had been treated with two or more anti-TNF-α agents. Treatment responses of the groups were measured and compared using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Visual Analog Scale (VAS). A posttreatment BASDAI score ≤4 was used as a criterion for remission.

Results: The mean duration of secukinumab treatment was 16.6±12.7 months for Group 1 and 16.0±11.6 months for Group 2 (p=0.84). Both groups responded significantly to secukinumab in terms of BASDAI and VAS scores (p<0.001 and p<0.001, respectively). Group 1 had a greater decline in BASDAI and VAS scores than Group 2 (p=0.045 and p=0.032, respectively). Furthermore, the remission rate was greater in Group 1 compared to Group 2 (58% vs. 34%, p=0.03). The adverse effects of secukinumab treatment were an allergic reaction in Group 1 and one case of ulcerative colitis in Group 2.

Conclusion: Second-line secukinumab treatment resulted in a greater decline in BASDAI and VAS scores. Moreover, secukinumab achieved a significantly higher rate of remission when it was used as second-line therapy after one anti-TNF-α agent.

Citation: Ak T, Mustafayeva L, Ayla AY, Celik Y, Can G, Ugurlu S. Secukinumab after first-line tumor necrosis factor-alpha inhibitor therapy in psoriatic arthritis: A real-world retrospective cohort study. Arch Rheumatol 2024;39(1):71-80. doi: 10.46497/ArchRheumatol.2024.10050.

Ethics Committee Approval

The study protocol was approved by the Cerrahpaşa Medical Faculty Clinical Research Ethics Committee (date: 11.10.2021, no: 203356). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Wrote the manuscript: T.A., A.Y.A.; Reviewed the literature to provide a basis for discussion: T.A.; Collected the patients’ data: T.A., L.M., Y.C.; Performed the statististical analysis: G.C.; Interpreted the results: T.A., A.Y.A., G.C., S.U.; Designed the study and acted as supervisor: S.U., T.A., L.M., Y.C., A.Y.A., G.C.; Provided critical review, integrity and clarity to the manuscript: S.U.; All authors discussed the conclusions and approved the final version.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.