Luca Iorio, Federica Davanzo, Caterina Ricordi, Milena Bond, Ruggiero Mascolo, Jacopo Mora, Alessandro Tomelleri, Angelo Fassio, Francesca Cuzzocrea, Sara Monti, Edoardo Conticini, Fabiola Atzeni, Paolo Delvino, Carlotta Nannini, Augusta Ortolan, Francesco Pollastri, Ester Vivaldelli, Chiara Marvisi, Paola Toniati, Antonio Brucato, Alessandra Milanesi, Francesca Regola, Enrico Tombetti, Lorenzo Dagna, Roberta Ramonda, Christian Dejaco, Luca Quartuccio, Carlo Salvarani, Roberto Padoan, Italian Society of Rheumatology Vasculitis Study Group
In this multicentre real-world cohort of patients with GCA, including those with relapsing disease and previous biologic exposure, secukinumab was associated with high observed remission rates, progressive GC dose reduction and increasing GC-free remission. Although the phase III GCAptAIN trial did not meet its primary endpoint, these findings suggest that IL-17A inhibition may warrant further evaluation in GCA patients.
OBJECTIVE: The objective of this study was to evaluate the real-world effectiveness and safety of secukinumab in giant cell arteritis (GCA) patients.
METHODS: This multicentre retrospective study included patients with GCA who received secukinumab at 14 Italian centres with at least 6 months of follow-up. Outcomes included clinical, complete and glucocorticoid (GC)-free remission, GC dose reduction, drug retention rate and adverse events.
RESULTS: Thirty-six patients were included (66.7% women); median age at secukinumab initiation was 74 (IQR 70-80) years. Overall, 32/36 patients (88.9%) had previously relapsed and 26/36 (72.2%) had received tocilizumab. Clinical remission was observed in 85.2%, 80.6% and 83.3% at 3, 6 and 12 months, respectively. Complete remission occurred in 55.6%, 52.8% and 63.3%, while GC-free remission increased progressively, reaching 14.8%, 27.8% and 40.0% at 3, 6, and 12 months, respectively (p = 0.012). Median daily GC dose decreased from 8.7 [4.0-21.2] mg at baseline to 0 [0-5.0] mg at 12 months (p < 0.001); GCs were discontinued in 12/28 patients (42.9%). The 12-month retention rate was 77.0%. Adverse events occurred in 20/36 patients (55.6%); infections occurred in 18/36 (50.0%) patients, accounting for 21 infectious episodes.
CONCLUSION: In this multicentre real-world cohort of patients with GCA, including those with relapsing disease and previous biologic exposure, secukinumab was associated with high observed remission rates, progressive GC dose reduction and increasing GC-free remission. Although the phase III GCAptAIN trial did not meet its primary endpoint, these findings suggest that IL-17A inhibition may warrant further evaluation in GCA patients.