by Dr. David Borenstein M.D. 12/2019
Spine Community News Non-radiographic (nr) ankylosing spondylitis (AS) is considered an early phase of AS that occurs before x-ray findings of AS are visible. These patients however do have findings identifiable on magnetic resonance imaging (MRI) of the sacroiliac joints.
Interleukin-17 (IL-17) inhibitors
Interleukin-17 is a protein produced by immune cells that functions as a messenger between cells playing an important role in inflammation and the symptoms associated with AS, including morning stiffness, limited spine motion, and overall fatigue. Antibodies that target the IL-17 pathways are used for the treatment of several conditions in which the IL-17 pathway has a role, including AS and now based on new publications, nr-AS. Cosentyx (secukinumab) and Taltz (ixekisumab) are both anti-IL-17 monoclonal antibody that block the effects of IL-17 leading to an improvement in IL-17 associated symptoms.
Cosentyx (secukinumab) which is an anti-IL-17A biologic drug that is already approved for the treatment of AS was evaluated in the PREVENT clinical trial in nr-AS patients and the data was recently published at the 2019 American College of Rheumatology meeting.
In the PREVENT study 555 individuals with nr-AS patients were treated with Cosentyx 150 mg with or without a loading dose or placebo followed by monthly injections. The response to treatment was evaluated at 16 weeks from the initiation of therapy and the researchers reported a 40% improvement in a variety of symptoms including pain. Overall pain improvement occurred in 42% of the nr AS patients that received the loading dose. The treatment was well tolerated, and the no additional side effects were reported.
Taltz (Ixekizumab) is another anti-IL-17A biologic therapy that is approved for the treatment of AS. The COAST-X phase 3 clinical trial was designed to evaluate its effectiveness for the management of nr-AS. A total of 303 patients were treated with Taltz 80 mg every 2 weeks or very 4 weeks and compared to individuals with nr AS not receiving a biologic therapy. Improvement of pain and other symptoms was confirmed for both doses of Taltz at 16 weeks and 1 year from treatment compared to individuals who remained untreated with a biologic.
Both studies suggest that anti- IL-17 therapies know to be effective for AS are also effective for the management of nr-AS. Side effects associated with the use of IL-17 inhibitors include an increased risk of infections. Another very small risk is the development or worsening of inflammatory bowel disease.
Deodhar A et al. Secukinumab 150 mg Significantly Improved Signs and Symptoms of Non-radopgraphic Axial Spondyloarthritis: Results from a Phase 3 double-blind, Randomized, Placebo-controlled Study (abstract L21) Arthritis Rheumatol 2019;71 (suppl 10)
Deodhar A et al. Ixekizumab in Non-Radiographic Axial Spondyloarthritis: Primary Results from a phase 3 Trial .(abstract 2729) Arthritis Rheumatol 2019;71 (suppl 10)