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    Effectiveness of secukinumab in radiographic and non-radiographic axial spondyloarthritis: a European routine-care observational study
    (Bmj Publishing Group, 2024) Christiansen, Sara Nysom; Rasmussen, Simon Horskjaer; Ostergaard, Mikkel; Pons, Marion; Michelsen, Brigitte; Pavelka, Karel; Codreanu, Catalin
    Objectives To compare the treatment effectiveness of secukinumab in radiographic (r) versus non- radiographic (nr) axial spondyloarthritis (axSpA) patients treated in routine care across Europe. Methods Prospectively collected data on secukinumab- treated axSpA patients with known radiographic status were pooled from nine countries.Remission rates based on patient- reported outcomes (PROs; Numeric Rating Scale (0-10), for example, pain <= 2/Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <= 2 and Ankylosing Spondylitis Disease Activity Score (ASDAS) inactive disease (ID) <1.3 after 6/12/24 months of secukinumab treatment were calculated.Remission and drug retention rates in r- axSpA versus nr- axSpA patients were compared by logistic and Cox regression models (unadjusted/adjusted for age+sex/adjusted for multiple confounders).Results Overall, 1161 secukinumab- treated patients were included (r- axSpA/nr- axSpA: 922/239). At baseline, r- axSpA patients had longer disease duration and higher C reactive protein, were more often male and HLA- B27 positive and had received fewer prior biological or targeted synthetic disease- modifying antirheumatic drugs compared with nr- axSpA patients, whereas PROs were largely similar.During follow- up, crude PRO remission rates were significantly higher in r- axSpA compared with nr- axSpA patients (6 months: pain <= 2: 40%/28%, OR=1.7; BASDAI <= 2: 37%/25%, OR=1.8), as were drug retention rates (24 months: 66%/58%, HR 0.73 (ref: r- axSpA)). Proportions of patients achieving ASDAS ID were low for both groups, particularly nr- axSpA (6 months: 11%/8%) However, when adjusting for age+sex, these differences diminished, and after adjusting for multiple confounders, no significant between- group differences remained for either remission or drug retention rates.Conclusion Crude remission/drug retention rates in European secukinumab- treated patients were higher n r- axSpA compared with nr- axSpA patients. In adjusted analyses, secukinumab effectiveness was similar in both groups, suggesting that observed differences were related to factors other than radiographic status.