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Comparison of Secukinumab and Adalimumab-adaz in Axial Spondyloarthritis

Core Concepts
Secukinumab and adalimumab-adaz show similar efficacy in limiting spinal radiographic progression in axial spondyloarthritis.
The content discusses a phase 3b, randomized controlled trial comparing the efficacy of secukinumab and adalimumab-adaz in limiting spinal radiographic progression in patients with radiographic axial spondyloarthritis (r-axSpA). Key highlights include: Both drugs target different pathways but show similar efficacy. Limited data exist on the effect of biologic disease-modifying antirheumatic drugs (bDMARDs) in slowing radiographic progression in axSpA. The SURPASS trial enrolled 859 biologic-naive adult patients with r-axSpA. No significant differences were observed between the treatment groups in terms of radiographic progression. Both secukinumab and adalimumab-adaz demonstrated effectiveness in improving symptoms and physical function. The study did not definitively answer whether bDMARDs can modify structural progression. Researchers continue to explore mechanisms of disease progression in axSpA.
The proportion of patients with no radiographic progression at week 104 was 66.1% in the secukinumab 150-mg arm, 66.9% in the secukinumab 300 mg arm, and 65.6% in the adalimumab-adaz arm. The mean change from baseline in modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) was 0.54, 0.55, and 0.72, respectively. More than half of the patients with at least one syndesmophyte at baseline did not develop new syndesmophytes over the 2-year period.
"Anti-TNF therapy has been considered the gold standard treatment for axial spondyloarthritis in terms of slowing or halting radiographic progression." - Dr. Xenofon Baraliakos "After 2 years, no difference was observed in the percentage of patients with no progression across the study arms." - Dr. Alexandre Sepriano

Key Insights Distilled From

by Elena Ribold... at 06-01-2023
Two Biologics Show No Difference in Axial Spondyloarthritis

Deeper Inquiries

What are the implications of the study results for the treatment of axial spondyloarthritis?

The study results comparing secukinumab and adalimumab-adaz in patients with radiographic axial spondyloarthritis (r-axSpA) have significant implications for treatment. The findings suggest that both biologics have similar efficacy in limiting spinal radiographic progression over a 2-year period. This is crucial as it provides clinicians with more options when selecting a treatment approach for patients with axSpA. The study indicates that IL-17 inhibition with secukinumab is at least as effective as TNF blockade with adalimumab in slowing radiographic progression, challenging the notion that anti-TNF therapy is the gold standard for this purpose. These results offer reassurance that both treatment options can be considered effective in addressing structural damage in axSpA, providing more flexibility in personalized treatment plans for patients.

Is there a potential downside to considering both secukinumab and adalimumab-adaz as equally effective in limiting structural progression?

While the study results suggest that both secukinumab and adalimumab-adaz are comparable in limiting structural progression in axial spondyloarthritis, there could be potential downsides to considering them as equally effective. One downside is the lack of differentiation in treatment selection based on individual patient characteristics or comorbidities. Different patients may respond differently to each biologic, and considering them as equally effective may overlook the nuances in patient profiles that could influence treatment outcomes. Additionally, not all patients may have access to both medications due to factors such as cost, insurance coverage, or availability. Therefore, while the study results are promising in demonstrating similar efficacy, it is essential for clinicians to carefully evaluate each patient's unique needs and characteristics to determine the most appropriate treatment option for optimal outcomes.

How can advancements in quantifying structural progression in axSpA impact future treatment strategies?

Advancements in quantifying structural progression in axial spondyloarthritis (axSpA), such as the use of low-dose CT scans with greater sensitivity to change, can have a significant impact on future treatment strategies. By improving the ability to accurately measure structural changes in the spine and sacroiliac joints, these advancements enable clinicians to monitor disease progression more effectively and make informed treatment decisions. The increased sensitivity of these methods allows for earlier detection of changes, potentially leading to timely interventions to prevent irreversible damage. Additionally, more precise quantification of structural progression can aid in assessing the effectiveness of different treatment modalities, guiding clinicians in selecting the most appropriate therapy for individual patients. Overall, advancements in quantifying structural progression in axSpA have the potential to enhance patient outcomes by facilitating personalized treatment approaches and optimizing disease management strategies.