UNEXPECTEDLY, a recent study showed that increasing secukinumab dosage to 300 mg offers no additional clinical benefit for patients with ankylosing spondylitis patients who failed to achieve inactive disease after initial treatment with 150 mg.
The ASLeap trial, a multicenter, Phase IV study, examined patients with inadequate response to secukinumab 150 mg after 16 weeks, defined as an Ankylosing Spondylitis Disease Activity Score (ASDAS) of less than 1.3. Patients were randomized to either continue on 150 mg or escalate to 300 mg of secukinumab every 4 weeks until Week 52. The aim of the study was to determine if a higher dose could help more patients achieve inactive disease by the 1-year mark. Out of 322 patients initially treated with secukinumab 150 mg, 64.3% (207 patients) had an inadequate response at Week 16. Among those, 101 received the 300 mg dose, and 105 continued on the 150 mg dose. At Week 52, only 8.8% of patients on the higher dose achieved inactive disease compared to 6.7% of those who continued with the standard dose.
Safety profiles were similar across both groups, with treatment-emergent adverse events occurring in 63.4% of patients in the 300 mg group and 68.6% in the 150 mg group. According to the study, no new safety concerns were identified, aligning with existing secukinumab safety data. The study was conducted by Atul Deodhar, lead investigator and Professor of Medicine and Medical Director at the Division of Arthritis & Rheumatic Diseases, and colleagues from Oregon Health & Science University, Portland.
In conclusion, dose escalation did not significantly improve clinical outcomes in patients who had already shown an inadequate response to 150 mg. The research group noted that while dose escalation may not be universally beneficial, it could be considered for specific subsets of patients with moderate responses to lower doses. These findings highlight the need for personalized treatment approaches in managing AS.
Reference: Deodhar A et al. A secukinumab dose-escalation study in patients with ankylosing spondylitis not achieving inactive disease after 16 weeks of treatment. Rheumatology. 2024;keae432.
Anaya Malik | AMJ
