OBJECTIVE: In patients with axial spondyloarthritis (axSpA) initiating secukinumab (SEC), we aimed to identify baseline (treatment start) predictors of achieving low disease activity (LDA) after 6 months, as measured by the Axial Spondyloarthritis Disease Activity Score using C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), as well as treatment continuation after 12 months. METHODS: From 11 European registries, patients with axSpA who initiated SEC treatment in routine care, with available data on 6-month ASDAS-CRP and BASDAI assessments were included. Logistic regression analyses on multiply imputed baseline data were performed; potential baseline predictors included demographic, diagnosis, lifestyle, clinical, and patient-reported variables. RESULTS: In a pooled cohort of 1174 patients with axSpA, 5 of 19 potential assessed variables were mutually predictive for achieving LDA by ASDAS-CRP and BASDAI: higher physician global assessment score, noncurrent smoking, lack of prior exposure to biologic/targeted synthetic disease-modifying antirheumatic drugs, and lower Health Assessment Questionnaire scores and BASDAI scores. Moreover, radiographic axSpA and CRP ≤ 10 mg/L were associated with achieving ASDAS-CRP LDA, and HLA-B27 positivity and history of psoriasis with achieving BASDAI LDA, whereas earlier time of secukinumab initiation (2015-2017) was associated with treatment continuation. CONCLUSION: In this European real-world study of patients with axSpA initiating SEC, predictors of achieving LDA by ASDAS-CRP and BASDAI at 6 months and remaining on treatment at 12 months included both clinical, patient-reported, and lifestyle factors, underscoring the complex mechanisms of real-world drug effectiveness.

1 Castrejón MD PhD Department of Rheumatology Hospital General Universitario Gregorio Marañón and Faculty of Medicine Complutense University of Madrid Madrid Spain

1 van der Horst Bruinsma MD PhD Rheumatology Radboud University Medical Center Nijmegen the Netherlands

5 Rantalaiho PhD Tampere University Hospital Centre for Rheumatic Diseases and Tampere University Faculty of Medicine and Health Technology Tampere and Department of Internal Medicine Kanta Häme Central Hospital Hämeenlinna Finland

A Ciurea MD PhD Department of Rheumatology University Hospital Zurich University of Zurich Zurich Switzerland

A G Loft MD DMSc Department of Rheumatology Aarhus University Hospital and Department of Clinical Medicine Aarhus University Aarhus Denmark

B Glintborg MD PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Rigshospitalet Glostrup and Department of Clinical Medicine University of Copenhagen Copenhagen and DANBIO Registry Rigshospitalet Glostrup Denmark

B Gudbjornsson MD PhD Centre for Rheumatology Research Landspitali University Hospital and Faculty of Medicine University of Iceland Reykjavik Iceland

B Michelsen PhD Copenhagen Center for Arthritis Research Diakonhjemmet Hospital Oslo and Research Unit Sørlandet Hospital Kristiansand Norway

C Codreanu PhD Center for Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania

D Di Giuseppe PhD Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden

G J Macfarlane MD PhD Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen UK

H Santos MD PhD Instituto Português de Reumatologia and Comprehensive Health Research Center Nova Medical School Lisbon Portugal

J K Wallman MD PhD Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden

K Laas PhD Department of Rheumatology East Tallinn Central Hospital Tallinn Estonia

K P Pirkmajer PhD Z Rotar MD PhD Department of Rheumatology University Medical Centre Ljubljana and Faculty of Medicine University of Ljubljana Ljubljana Slovenia

K Pavelka MD PhD J Závada MD PhD Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

L Kuusalo PhD Centre for Rheumatology and Clinical Immunology Turku University Hospital and Department of Internal Medicine University of Turku Turku Finland

M H Lourenço PhD Rheumatology Department Centro Hospitalar de Lisboa Ocidental and Comprehensive Health Research Center NOVA Medical School Lisbon Portugal

M J Nissen MD PhD Department of Rheumatology Geneva University Hospital Geneva Switzerland

M L Hetland MD PhD DMSc Z Faizy Ahmadzay MD M Østergaard MD PhD DMSc Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopedics Rigshospitalet Glostrup and Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

M Pons MD S Georgiadis PhD S Rasmussen PhD S N Christiansen PhD L M Ørnbjerg MD PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

M Pons MD S Georgiadis PhD S Rasmussen PhD S N Christiansen PhD L M Ørnbjerg MD PhD Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark;

M van de Sande MD PhD Amsterdam UMC University of Amsterdam Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology Amsterdam Institute for Infection and Immunity and Amsterdam Rheumatology Immunology Center Reade and Amsterdam UMC Amsterdam the Netherlands

O Palsson MD Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden and Faculty of Medicine University of Iceland Reykjavik Iceland

P Mielnik MD PhD Section for Rheumatology Department for Neurology Rheumatology and Physical Medicine Helse Førde Førde Norway

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