TOPLINE:

Among patients with spondyloarthritis (SpA) who initiated or switched to either secukinumab or TNF inhibitors, secukinumab demonstrated greater 4‑year persistence, with fewer discontinuations owing to safety concerns or the lack of efficacy. Obesity, sex, and disease phenotype significantly influenced efficacy‑related persistence rates.

METHODOLOGY:

• Researchers conducted a prospective single-center cohort study involving 644 patients with axial or peripheral SpA, including those with psoriatic arthritis, who initiated or switched to either secukinumab or TNF inhibitors between 2016 and 2022.
• Of these, 214 (median age, 52 years; 63% women) received secukinumab and 430 (median age, 52 years; 64% women) received TNF inhibitors.
• Sociodemographic characteristics, prior treatments, and comorbidities were recorded at inclusion, and disease characteristics (axial, peripheral, and extraarticular manifestations) together with ongoing treatments, disease activity, function, and quality‑of‑life measures were collected at inclusion, every 3-6 months for the first 2 years, and annually thereafter.
• The primary aim of this study was to investigate the 4‑year persistence of secukinumab therapy compared with that of TNF inhibitors and to explore potential effect modifiers of persistence.

TAKEAWAY:

• The 4-year treatment persistence was greater with secukinumab vs TNF inhibitors in the total SpA cohort (38.7% vs 30.5%; log-rank P = .004), with similar findings for axial SpA (37.0% vs 34.5%; log‑rank P = .044) and peripheral SpA (40.0% vs 18.2%; log‑rank P = .011).
• Treatment with TNF inhibitors was associated with a higher risk for discontinuation (hazard ratio [HR], 1.62; P < .001), including discontinuation for inefficacy (HR, 1.38; P = .047) and safety reasons (HR, 2.95; P = .017).
• The interaction analysis suggested no effect modification for safety-related discontinuations, but disease phenotype, sex, and obesity significantly modified efficacy-related persistence with secukinumab vs TNF inhibitors (P for interaction = .006, .040, and .045, respectively).
• At 6 months, the achievement of treatment targets was comparable between the two agents in patients with axial or peripheral SpA.

IN PRACTICE:

“Females had overall greater efficacy-related persistence with secukinumab than with TNFis [TNF inhibitors], especially for PsA [psoriatic arthritis] in both obese and nonobese individuals,” the researchers reported.

“With respect to axSpA [axial SpA] patients, female sex favored secukinumab efficacy-related persistence over TNFis only in obese patients…. These sex-specific findings, if verified in other SpA cohorts, could assist in guiding treatment decisions in everyday clinical practice,” they added.

SOURCE:

The study was led by Irini D. Flouri, MD, PhD, Rheumatology, Clinical Immunology and Allergy Department, University of Crete School of Medicine, Heraklion, Greece. It was published online on November 3, 2025, in Arthritis Research & Therapy.

LIMITATIONS: 

The observational nature of the study may have introduced potential confounding by indication, despite adjustments for various covariates. Researchers considered TNF inhibitors as a group rather than analyzing individual agents. Additionally, the sample size was insufficient for comparative evaluation of treatment response in specific patient subgroups to corroborate persistence analysis findings. 

DISCLOSURES:

This study was partially supported by grants from Novartis Hellas. Some authors declared receiving consulting or speaking fees, grants, or research support from various pharmaceutical companies, including Novartis.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.