Predisposing factors of secukinumab discontinuation at 1 year (univariate analysis)
| N=903† | % patients still on treatment at 1 year | Univariate Cox regressions | |||
| Predictive factor | Modality* (N) | HR (95% CI) | P value‡ | P type III | |
| At least one objective sign of inflammation | No = (N=97)* | 65.3% | 1.20 (0.84 to 1.72) | 0.316 | |
| Yes (N=616) | 58.8% | ||||
| Age (years) | ≤40 (N=288)* | 0.231 | |||
| >60 (N=108) | 59.3% | 0.90 (0.64 to 1.27) | 0.550 | ||
| 40–60 (N=507) | 61.3% | 0.82 (0.66 to 1.03) | 0.088 | ||
| Gender | Male (N=380)* | 50.9% | |||
| Female (N=523) | 59.2% | 1.03 (0.84 to 1.27) | 0.776 | ||
| BMI (kg/m2) | Normal weight (≥18.5 and <25) (N=200)* | 64.2% | |||
| Obesity (≥30) (N=133) | 63.4% | 1.03 (0.72 to 1.48) | 0.870 | 0.944 | |
| Pre-obesity (≥25 and <30) (N=186) | 60.8% | 1.09 (0.79 to 1.51) | 0.590 | ||
| Underweight (<18.5) (N=12) | 66.7% | 0.90 (0.33 to 2.47) | 0.840 | ||
| Smoking status (at secukinumab initiation) | Never (N324)* | 61.0% | 0.595 | ||
| Former smoker (N=158) | 60.8% | 1.02 (0.75 to 1.38) | 0.912 | ||
| Current smoker (N=231) | 57.4% | 1.14 (0.88 to 1.48) | 0.328 | ||
| Diagnosis delay (years) | ≤2.5 (N=289)* | 59.3% | 0.106 | ||
| 2.5 to ≤5 (N=89) | 71.1% | 0.63 (0.41 to 0.97) | 0.034 | ||
| <5 (N=179) | 59.8% | 0.91 (0.68 to 1.22) | 0.537 | ||
| Disease duration (years) | ≤5 (N=345)* | 57.7% | 0.573 | ||
| 5 to ≤(N=192) | 61.9% | 0.88 (0.67 to 1.17) | 0.385 | ||
| >10 (N=268) | 60.4% | 0.89 (0.70 to 1.15) | 0.378 | ||
| HLA-B27 positivity | No (N=297)* | 60.1% | |||
| Yes (N=525) | 58.8% | 1.05 (0.84 to 1.32) | 0.652 | ||
| Radiological structural damage according to mNY criteria | No (N=155)* | 55.8% | |||
| Yes (N=325) | 58.9% | 0.94 (0.70 to 1.25) | 0.666 | ||
| CRP≥5 mg/L or ESR≥28 mm if CRP not available | No (N=398) | 59.1% | 0.42 | ||
| Yes (N=282) | 62.4% | 0.90 (0.71 to 1.16) | 0.422 | ||
| Sign of inflammation in the MRI of the sacroiliitis or spine regardless of the date prior to the initial prescription of secukinumab | No (N=214) | 66.0% | 0.06 | ||
| Yes (N=487) | 57.4% | 1.29 (0.99 to 1.68) | 0.063 | ||
| Past or present history of active arthritis/synovitis diagnosed by a doctor | No (N=543) | 59.3% | |||
| Yes (N=258) | 62.8% | 0.88 (0.69 to 1.11) | 0.278 | ||
| Past or present history of psoriasis | No (N=589)* | 60.6% | 0.660 | ||
| Yes (N=199) | 58.3% | 1.06 (0.82 to 1.36) | 0.063 | ||
| Past or present history of uveitis | No (N=725)* | 59.6% | |||
| Yes (N=131) | 61.8% | 0.92 (0.68 to 1.24) | 0.576 | ||
| Past or present history of IBD (Crohn’s disease or haemorrhagic rectocolitis) | No (N=853)* | 59.8% | |||
| Yes (N=22) | 40.9% | 1.96 (1.13 to 3.41) | 0.017 | ||
| Secukinumab maintenance dose at initiation (per month) | 150 mg (N=747)* | 61.1% | 0.940 | ||
| 300 mg (N=88) | 62.5% | 0.94 (0.65 to 1.34) | 0.727 | ||
| Other (N=5) | 100% | <0.01 [0.01 to >999.99) | 0.963 | ||
| Secukinumab treatment line | First line (N71)* | 72.2% | 0.062 | ||
| Second line (N=133) | 62.7% | 1.49 (0.89 to 2.51) | 0.129 | ||
| ≥Third line (N=692) | 57.6% | 1.69 (1.08 to 2.66) | 0.023 | ||
| Concomitant treatment with csDMARDs at initiation | No (N=758)* | 59.4% | |||
| Yes (N=145) | 60% | 0.93 (0.70 to 1.23) | 0.604 | ||
| Oral corticosteroids intake at initiation of secukinumab | No (N=724)* | 60.5% | |||
| Yes (N=57) | 63.2% | 0.90 (0.58 to 1.40) | 0.633 | ||
| History of depression or anti-depressive concomitant treatment | No (N=703)* | 60.8% | |||
| Yes (N=165) | 54.5% | 1.25 (0.97 to 1.61) | 0.089 | ||
| History or suspicion of fibromyalgia | No (N=787)* | 60.4% | |||
| Yes (N=89) | 52.8% | 1.25 (0.90 to 1.72) | 0.181 | ||
| History of depression or anti-depressive concomitant treatment or history or suspicion of fibromyalgia | No (N=641)* | 61.0% | |||
| Yes (N=226) | 55.3% | 1.22 (0.97 to 1.54) | 0.090 | ||
| Concomitant treatment with a PPI | No (N=609)* | 59.4% | |||
| Yes (N=246) | 59.5% | 0.99 (0.78 to 1.25) | 0.931 | ||
*The modality given in the first row (eg, ‘No’ for ‘At least one objective sign of inflammation’) defined the reference in the Cox model.
†Although the study included 906 axSpA patients, the Cox univariate analysis included 903 patients, since the time (days) to definitive discontinuation of secukinumab within the first year (≤365 days) could not be calculated for three patients.
‡ P value calculated against reference value.
axSpA, axial spondyloarthritis; BMI, body mass index; csDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs; HLA-B27, human leucocyte antigen B-27; IBD, inflammatory bowel disease; mNY, modified New York; N, size of the population; PPI, proton-pump inhibitor.