Efficacy and safety of secukinumab in patients with spondyloarthritis and enthesitis at the Achilles tendon: results from a phase 3b trial

Frank Behrens, Philipp Sewerin, Eugenio de Miguel, Yusuf Patel, Anastas Batalov, Eva Dokoupilova, Christine Kleinmond, Effie Pournara, Ankita Shekhawat, Claudia Jentzsch, Annette Wiedon, Xenofon Baraliakos, ACHILLES study group, Frank Behrens, Philipp Sewerin, Eugenio de Miguel, Yusuf Patel, Anastas Batalov, Eva Dokoupilova, Christine Kleinmond, Effie Pournara, Ankita Shekhawat, Claudia Jentzsch, Annette Wiedon, Xenofon Baraliakos, ACHILLES study group

Abstract

Objective: ACHILLES aimed to demonstrate efficacy of secukinumab on Achilles' tendon enthesitis in spondyloarthritis (SpA) patients.

Methods: Patients ≥18 years (n = 204) with active PsA or axial SpA and heel enthesitis were randomized 1:1 to secukinumab 150/300 mg or placebo up to week 24, and thereafter placebo patients were switched to secukinumab.

Results: At week 24, a higher, yet statistically non-significant (P = 0.136), proportion of patients in secukinumab vs placebo reported resolution of Achilles tendon enthesitis in affected foot (42.2% vs 31.4%; odds ratio [OR] = 1.63; 95% CI: 0.87, 3.08). Proportion of patients reporting resolution of enthesitis based on Leeds Enthesitis Index was higher with secukinumab vs placebo (33.3% vs 23.5%; OR = 1.65; 95% CI: 0.85, 3.25) at week 24. Mean change from baseline in heel pain at week 24 was higher in secukinumab patients vs placebo (-2.8 [3.0] vs -1.9 [2.7]). Greater improvements with secukinumab were observed in heel enthesopathy activity and global assessment of disease activity. Imaging evaluation by local reading confirmed heel enthesitis on MRI at screening for all patients. Based on central reading, 56% presented with bone marrow oedema and/or tendinitis; according to Heel Enthesitis MRI Scoring System (HEMRIS) post hoc analysis, 76% had signs of entheseal inflammation while 86% had entheseal inflammation and/or structural changes.

Conclusion: A substantial proportion of patients showed no signs of inflammation on the centrally read MRIs despite a clinical diagnosis of heel enthesitis, thus highlighting that the discrepancy between the clinical and imaging assessments of enthesitis requires further investigation. Although ACHILLES did not meet the primary end point, the study reported clinically meaningful improvements in patient-related outcomes.

Trial registration: clinicaltrials.gov, NCT02771210.

Keywords: Achilles tendon enthesitis; IL-17 inhibitor; biologics; bone marrow oedema; heel enthesitis; imaging outcomes; pain; spondyloarthritis.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig. 1
Fig. 1
Study design Patients were stratified by underlying disease (PsA or axSpA) and randomized 1:1 to receive either secukinumab or matching placebo. The dosage of secukinumab/placebo (150 or 300 mg) was predetermined at baseline according to axSpA or PsA disease, extent of psoriasis and pretreatment with TNF-inhibitor. MRI assessments were performed at screening, week 24 and week 52. axSpA: axial spondyloarthritis; BSL: baseline; R: randomization.
Fig. 2
Fig. 2
Patient disposition to week 52 Of the overall population, 19/204 (9.3%) subjects had been pre-treated with TNF-inhibitors; no meaningful differences in week 24 outcome parameter could be observed between TNF-naïve and TNF-pretreated subjects. axSpA: axial spondyloarthritis; BSL: baseline; r-axSpA: radiographic axial spondyloarthritis; nr-axSpA: non-radiographic axial spondyloarthritis; W: week.
Fig . 3
Fig. 3
Resolution of Achilles tendon enthesitis in affected foot (A) data presented with imputed missing values; n = 102 in each group; P = 0.136 for secukinumab vs placebo at week 24. (B) Data presented as observed; number of patients with non-missing value: n = 89 at week 24 and n = 84 at week 52 in secukinumab group, n = 86 at week 24 and n = 79 at week 52 in placebo group. BSL: baseline.

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Source: PubMed

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