Anti-interleukin-17A monoclonal antibody secukinumab in treatment of ankylosing spondylitis: a randomised, double-blind, placebo-controlled trial.

Abstract

BACKGROUND:

Ankylosing spondylitis is a chronic immune-mediated inflammatory disease characterised by spinal inflammation, progressive spinal rigidity, and peripheral arthritis. Interleukin 17 (IL-17) is thought to be a key inflammatory cytokine in the development of ankylosing spondylitis, the prototypical form of spondyloarthritis. We assessed the efficacy and safety of the anti-IL-17A monoclonal antibody secukinumab in treating patients with active ankylosing spondylitis.

METHODS:

We did a randomised double-blind proof-of-concept study at eight centres in Europe (four in Germany, two in the Netherlands, and two in the UK). Patients aged 18-65 years were randomly assigned (in a 4:1 ratio) to either intravenous secukinumab (2×10 mg/kg) or placebo, given 3 weeks apart. Randomisation was done with a computer-generated block randomisation list without a stratification process. The primary efficacy endpoint was the percentage of patients with a 20% response according to the Assessment of SpondyloArthritis international Society criteria for improvement (ASAS20) at week 6 (Bayesian analysis). Safety was assessed up to week 28. This study is registered with ClinicalTrials.gov, number NCT00809159.

FINDINGS:

37 patients with moderate-to-severe ankylosing spondylitis were screened, and 30 were randomly assigned to receive either intravenous secukinumab (n=24) or placebo (n=6). The final efficacy analysis included 23 patients receiving secukinumab and six patients receiving placebo, and the safety analysis included all 30 patients. 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.

INTERPRETATION:

Secukinumab rapidly reduced clinical or biological signs of active ankylosing spondylitis and was well tolerated. It is the first targeted therapy that we know of that is an alternative to tumour necrosis factor inhibition to reach its primary endpoint in a phase 2 trial.

FUNDING:

Novartis.

• Authors: Dominique Baeten, Xenofon Baraliakos, Jürgen Braun, Joachim Sieper, Paul Emery, Désirée van der Heijde, Iain McInnes, Jacob M van Laar, Robert Landewé, Paul Wordsworth, Jürgen Wollenhaupt, Herbert Kellner, Jacqueline Paramarta, Jiawei Wei, Arndt Brachat, Stephan Bek, Didier Laurent, Yali Li, Ying A Wang, Arthur P Bertolino, Sandro Gsteiger, Andrew M Wright, Wolfgang Hueber
• Journal: Lancet (London, England) (Lancet) Vol. 382 Issue 9906 Pg. 1705-13 (Nov 23 2013) ISSN: 1474-547X [Electronic] England
• PMID: 24035250 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Biomarkers
• secukinumab

Topics

• Abscess (chemically induced)
• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (administration & dosage, adverse effects)
• Biomarkers (metabolism)
• Double-Blind Method
• Female
• Humans
• Infusions, Intravenous
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Spondylitis, Ankylosing (complications, drug therapy)
• Staphylococcal Skin Infections (chemically induced)
• Staphylococcus aureus
• Treatment Outcome
• Young Adult