The majority of available data on the safety of secukinumab (SEC) in patients with latent tuberculosis infection (LTBI) and hepatitis B virus infection (HBV) is derived from patients with psoriasis. However, a recent study has provided additional insights into the safety of SEC in Chinese axial spondyloarthritis (axSpA) patients with concurrent HBV infection or LTBI.
Suling Liu and their team conducted a retrospective cohort study, which included 43 axSpA patients with HBV or LTBI infections. Among patients with concurrent HBV infection, approximately 16.2% reported reactivation after an average of 9.0 ± 5.7 months of SEC treatment. This group comprised one patient with occult HBV infection who did not receive antiviral prophylaxis, two patients with chronic HBV infection who also did not receive antiviral prophylaxis, and three patients with chronic HBV infection who received anti-HBV prophylaxis. Notably, among the six axSpA patients with LTBI, none of them experienced reactivation of the infection regardless of whether they received anti-TB prophylaxis or not.
A multicentric Italian cohort study conducted in 2021 has provided evidence for the safety and effectiveness of SEC in patients with psoriatic arthritis. The study demonstrated the efficacy of SEC through improvements in various outcomes, including the Disease Activity Index for Psoriatic Arthritis and the Ankylosing Spondylitis Disease Activity Score. Comparing baseline measurements to the 24-month mark, significant improvements were observed (baseline, T0=25.29 (11.14) vs. 24 months, T24=7.69 (4.51); p<0.01). Biologic-naïve patients at T24 exhibited lower Psoriasis Area Severity Index (p=0.04), erythrocyte sedimentation rate, C-reactive protein (p=0.03; p=0.05), and joint count (p=0.03) compared to the multifailure group. Furthermore, at T24, 75.71% of biologic-naïve patients and 70.37% of multifailure patients achieved minimal disease activity. Approximately 20.23% of patients had their treatment discontinued, primarily due to primary or secondary loss of efficacy, with 22 patients experiencing adverse effects. The overall population’s retention rate at T24 was 71%, with some variations observed based on SEC dosage (p=0.004) and gender (p=0.05).
HBV reactivation can occur in axSpA patients receiving SEC treatment for different types of HBV infection, regardless of whether they receive antiviral prophylaxis. Close monitoring for HBV reactivation is crucial in axSpA patients with HBV infection who are undergoing SEC therapy. Additionally, anti-HBV vaccination may provide benefits in this context. On the other hand, the use of SEC in axSpA patients with LTBI appears to be safe, even in those who are not receiving anti-TB prophylaxis.
.References
- Liu S, He Z, Wu W, Jin H, Cui Y. Safety of secukinumab in the treatment of patients with axial spondyloarthritis and concurrent hepatitis B virus infection or latent tuberculosis infection. Clinical Rheumatology. 2023 May 23:1-8.
- Ramonda R, Lorenzin M, Carriero A, Chimenti MS, Scarpa R, Marchesoni A, et al. Effectiveness and safety of secukinumab in 608 patients with psoriatic arthritis in real life: a 24-month prospective, multicentre study. RMD open. 2021 Feb 1;7(1):e001519.