PO:02:018 | After-SECs: clinical predictors of secukinumab retention in psoriatic arthritis patients with inadequate response to anti-tumor necrosis factor therapy

Francesco Cristiano¹, Davide Gaspare Patti¹, Valentina Boni¹, Stefano Di Murro¹, Cesare Gavotti¹, Roberta Masnata¹, Giulia Calabrese², Gerlando Natalello², Giusy Peluso², Augusta Ortolan^1|2, Enrico De Lorenzis^1|2, Maria Antonietta D'Agostino^1|2. | ¹Università Cattolica del Sacro Cuore, Roma, Italy; ²Divisione di Reumatologia ed Immunologia clinica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.

Background. A range of molecular targets is currently available for the treatment of psoriatic arthritis (PsA). Identifying clinical predictors of treatment persistence is critical for optimizing therapeutic strategies, as drug retention is often used as a proxy for long-term efficacy and safety. This study aimed to evaluate predictors of secukinumab (SEC) retention in PsA patients who previously discontinued the anti-TNF agent adalimumab (ADA).

Methods. PsA patients who initiated SEC following ADA discontinuation between 2019 and 2024 were retrospectively analyzed. Clinical data were collected through systematic chart reviews, including demographic characteristics, involved disease domains, prior treatments, and metabolic comorbidities [e.g., increased body mass index (BMI), diabetes]. SEC treatment persistence was assessed over a follow-up period of up to 36 months. Survival analysis was performed using SEC discontinuation as the event, with demographic and clinical variables as predictors.

Results. Among 327 PsA patients treated with SEC during the study period, 67 had previously discontinued ADA – 54 (81%) due to inadequate response and 13 (19%) due to adverse events. Patients’ characteristics are detailed in Table 1. Over a median follow-up of 1.6 years (Interquartile Range (IQR) 0.7–2.4), 26 SEC discontinuations were recorded, corresponding to an incidence rate of 24.8 per 100 patient-years. SEC retention rates at 12, 24, and 36 months were 69.8% (95% Confidence Interval (CI) 59.3–82.2), 61.6% (95% CI 49.7–76.5), and 49.1% (95% CI 36.0–67.0), respectively. The presence of enthesitis (Hazard Ratio (HR) 0.28, 95% CI 0.08–0.96) and concomitant active skin psoriasis (HR 0.21, 95% CI 0.08–0.59) were significantly associated with a lower risk of SEC discontinuation.

Conclusions. Secukinumab showed higher retention rates in PsA patients with enthesitis and active skin psoriasis after ADA discontinuation. No significant associations were found with demographic variables or metabolic comorbidities. These findings may assist clinicians in identifying patients who are more likely to benefit from IL-17 inhibition following anti-TNF therapy failure.