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 in 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.

Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen UK

Amsterdam Rheumatology and Immunology Center Amsterdam Netherlands

Amsterdam UMC Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology Amsterdam Institute for Infection and Immunity University of Amsterdam Amsterdam Netherlands

Center for Rheumatic Diseases University of Medicine and Pharmacy Carol Davila Bucharest Bucuresti Romania

Center for treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

Centre for Rheumatology Research Landspitali National University Hospital of Iceland Reykjavik Iceland

Clinical Epidemiology Division Department of Medicine Solna Karolinska Institute Stockholm Sweden

Comprehensive Health Research Centre NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Rigshospitalet Glostrup Glostrup Denmark

Department for Rheumatology Landspitali National University Hospital of Iceland Reykjavik Iceland

Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Sciences Lund Lund University Lund Sweden

Department of Medicine Helsinki University and Helsinki University Hospital Helsinki Finland

Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology Bakircay Universitesi Izmir Turkey

Department of Rheumatology East Tallinn Central Hospital Tallinn Estonia

Department of Rheumatology Geneva University Hospitals Geneve Switzerland

Department of Rheumatology Hospital Garcia de Orta EPE Almada Portugal

Department of Rheumatology Hospital General Universitario Gregorio Marañón Madrid Spain

Department of Rheumatology Skåne University Hospital Lund Lund Sweden

Department of Rheumatology University Hospital Zurich Zurich Switzerland

Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia

Division of Rheumatology Dokuz Eylul Universitesi Tip Fakultesi Izmir Turkey

Faculdade de Medicina da Universidade de Lisboa Universidade de Lisboa Instituto de Medicina Molecular Lisboa Portugal

Faculty of Medicine Complutense University of Madrid Madrid Spain

Faculty of Medicine University of Iceland Reykjavik Iceland

Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Faculty of Medicine University of Oslo Oslo Norway

Inflammation Center Rheumatology Helsinki University Central Hospital Helsinki Finland

Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Praha Czech Republic

National Institute for Health Development Tallinn Estonia

Public Health Section Inland Norway University of Applied Sciences Elverum Norway

Research Unit Sørlandet Sykehus HF Kristiansand Norway

Research Unit Spanish Society of Rheumatology Madrid Spain

Rheumatology Allergology and Clinical Immunology University of Rome Tor Vergata Roma Italy

Rheumatology Department Centro Hospitalar do Baixo Vouga EPE Aveiro Portugal

Rheumatology Radboud University Medical Center Nijmegen Netherlands

Rheumatology Unit DiMePRe J University of Bari Bari Italy

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