Drug Retention Rate and Factors Associated with Discontinuation of Interleukin-17 Inhibitors in Patients with Axial Spondyloarthritis

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2023 Nov 22

PMID 37992741

Authors

Oh Chan Kwon

Min-Chan Park

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess the drug retention rate of interleukin-17 inhibitors (IL-17is) over long-term observation in patients with axial spondyloarthritis (axSpA) in whom treatment with tumor necrosis factor inhibitors (TNFis) failed and to determine baseline factors associated with discontinuation of IL-17is.

Materials And Methods: This retrospective cohort study included 68 patients with axSpA started on IL-17is after an inadequate response or intolerance to ≥1 TNFis. Drug retention rates at 1, 2, and 3 years were assessed. Baseline (i.e., at initiation of IL-17is) factors associated with discontinuation of IL-17is were evaluated using multivariable Cox proportional hazard regression analysis.

Results: Over 1933.9 person-months of observation in 68 patients, discontinuation of IL-17is occurred in 27 (39.7%) patients. Twenty (29.4%) patients discontinued IL-17is because of ineffectiveness, and 7 (10.3%) patients discontinued IL-17is because of adverse events. The 1-year, 2-year, and 3-year drug retention rates for IL-17is were 71.9%, 66.5%, and 62.0%, respectively. Current smoking was associated with a higher risk of IL-17is discontinuation [adjusted hazard ratio (HR)=2.256, 95% confidence interval (CI)=1.053-4.831, =0.036], while previous use of ≥3 TNFis (vs. 1) was significantly associated with a lower risk of IL-17is discontinuation (adjusted HR=0.223, 95% CI=0.051-0.969, =0.045).

Conclusion: In patients with axSpA in whom TNFis failed, the long-term drug retention rate of IL-17is appears to be acceptable, with a 3-year drug retention rate of approximately 60%. Current smoking was associated with a higher risk of discontinuing IL-17is, whereas previous use of ≥3 TNFis was associated with a lower risk of discontinuing IL-17is.

Citing Articles

Cardiovascular risk according to biological agent exposure in patients with ankylosing spondylitis: a nationwide population-based study.

Kwon O, Lee H, Yang J, Park M Clin Rheumatol. 2024; 44(1):257-266.

PMID: 39509079 DOI: 10.1007/s10067-024-07225-7.

References

Zhang H, Wan W, Liu J, Dai S, Zou Y, Qian Q . Smoking quantity determines disease activity and function in Chinese patients with ankylosing spondylitis. Clin Rheumatol. 2018; 37(6):1605-1616. DOI: 10.1007/s10067-018-4016-3. View

Min H, Kim H, Lee S, Hong Y, Kim M, Park S . Retention rate and effectiveness of secukinumab vs TNF inhibitor in ankylosing spondylitis patients with prior TNF inhibitor exposure. Rheumatology (Oxford). 2021; 60(12):5743-5752. DOI: 10.1093/rheumatology/keab245. View

Alonso S, Villa I, Fernandez S, Martin J, Charca L, Pino M . Multicenter Study of Secukinumab Survival and Safety in Spondyloarthritis and Psoriatic Arthritis: SEcukinumab in Cantabria and ASTURias Study. Front Med (Lausanne). 2021; 8:679009. PMC: 8187784. DOI: 10.3389/fmed.2021.679009. View

Davis Jr J, van der Heijde D, Braun J, Dougados M, Cush J, Clegg D . Recombinant human tumor necrosis factor receptor (etanercept) for treating ankylosing spondylitis: a randomized, controlled trial. Arthritis Rheum. 2003; 48(11):3230-6. DOI: 10.1002/art.11325. View

van der Linden S, VALKENBURG H, Cats A . Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27(4):361-8. DOI: 10.1002/art.1780270401. View

Zhao S, Challoner B, Khattak M, Moots R, Goodson N . Increasing smoking intensity is associated with increased disease activity in axial spondyloarthritis. Rheumatol Int. 2016; 37(2):239-244. PMC: 5258786. DOI: 10.1007/s00296-016-3590-4. View

Fraenkel L, Bathon J, England B, St Clair E, Arayssi T, Carandang K . 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2021; 73(7):1108-1123. DOI: 10.1002/art.41752. View

Chimenti M, Lavinia Fonti G, Conigliaro P, Sunzini F, Scrivo R, Navarini L . One-year effectiveness, retention rate, and safety of secukinumab in ankylosing spondylitis and psoriatic arthritis: a real-life multicenter study. Expert Opin Biol Ther. 2020; 20(7):813-821. DOI: 10.1080/14712598.2020.1761957. View

Armagan B, Kilic L, Farisogullari B, Yardimci G, Bilgin E, Bolek E . Drug retention rate and predictive factors of drug survival for secukinumab in radiographic axial spondyloarthritis. Rheumatol Int. 2022; 43(1):147-156. DOI: 10.1007/s00296-022-05213-1. View

10.

Glintborg B, Ostergaard M, Krogh N, Dreyer L, Kristensen H, Hetland M . Predictors of treatment response and drug continuation in 842 patients with ankylosing spondylitis treated with anti-tumour necrosis factor: results from 8 years' surveillance in the Danish nationwide DANBIO registry. Ann Rheum Dis. 2010; 69(11):2002-8. DOI: 10.1136/ard.2009.124446. View

11.

Kwon O, Park J, Park M . Factors affecting drug survival of an alternative TNF inhibitor and secukinumab in patients with ankylosing spondylitis switching from the first TNF inhibitor. Ther Adv Musculoskelet Dis. 2021; 13:1759720X211009021. PMC: 8047974. DOI: 10.1177/1759720X211009021. View

12.

Pantano I, Iacono D, Favalli E, Scalise G, Costa L, Caso F . Secukinumab efficacy in patients with PsA is not dependent on patients' body mass index. Ann Rheum Dis. 2020; 81(3):e42. DOI: 10.1136/annrheumdis-2020-217251. View

13.

Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M . EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020; 79(6):700-712. PMC: 7286048. DOI: 10.1136/annrheumdis-2020-217159. View

14.

Garrett S, Jenkinson T, Kennedy L, Whitelock H, Gaisford P, Calin A . A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21(12):2286-91. View

15.

Ward M, Deodhar A, Gensler L, Dubreuil M, Yu D, Khan M . 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2019; 71(10):1599-1613. PMC: 6764882. DOI: 10.1002/art.41042. View

16.

Poddubnyy D, Haibel H, Listing J, Marker-Hermann E, Zeidler H, Braun J . Baseline radiographic damage, elevated acute-phase reactant levels, and cigarette smoking status predict spinal radiographic progression in early axial spondylarthritis. Arthritis Rheum. 2011; 64(5):1388-98. DOI: 10.1002/art.33465. View

17.

van der Heijde D, Kivitz A, Schiff M, Sieper J, Dijkmans B, Braun J . Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2006; 54(7):2136-46. DOI: 10.1002/art.21913. View

18.

Smolen J, Landewe R, Bergstra S, Kerschbaumer A, Sepriano A, Aletaha D . EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2022; 82(1):3-18. DOI: 10.1136/ard-2022-223356. View

19.

Lukas C, Landewe R, Sieper J, Dougados M, Davis J, Braun J . Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2008; 68(1):18-24. DOI: 10.1136/ard.2008.094870. View

20.

Lie E, van der Heijde D, Uhlig T, Mikkelsen K, Rodevand E, Koldingsnes W . Effectiveness of switching between TNF inhibitors in ankylosing spondylitis: data from the NOR-DMARD register. Ann Rheum Dis. 2010; 70(1):157-63. DOI: 10.1136/ard.2010.131797. View