Multicenter Study of Secukinumab Uptitration in Axial Spondyloarthritis: Real-World Evidence
Bibliographic record
Abstract
Objective To evaluate the real-world effectiveness, treatment retention, and safety of secukinumab (SEC) uptitration to 300 mg in patients with axial spondyloarthritis (axSpA), including radiographic (r-axSpA) and nonradiographic (nr-axSpA) subtypes, with active disease despite receiving SEC 150 mg every 4 weeks. Methods This multicenter, retrospective study included patients with axSpA who had received SEC 150 mg for ≥ 3 months and had active disease (Axial Spondyloarthritis Disease Activity Score [ASDAS] ≥ 2.1) at the time of dose escalation. Patients were followed for up to 24 months after escalation. Effectiveness was assessed through changes in ASDAS over time. Treatment retention was analyzed using Kaplan-Meier curves, with factors associated with discontinuation explored by Cox regression. Safety outcomes were reported as incidence of adverse events (AEs). Results Among 106 patients (77 r-axSpA, 29 nr-axSpA), ASDAS significantly declined within 6 months and was sustained through 24 months. Median ASDAS decreased from 4.1 to 2.0 in patients with r-axSpA and from 4.1 to 2.0 in those with nr-axSpA. Overall, 85.9% of patients achieved ASDAS ≤ 2.1 at least once after escalation. Retention of SEC 300 mg was 87.8% at 6 months and 59.1% at 24 months, with no significant difference between subtypes (log-rank P = 0.48). HLA-B27 positivity showed a nonsignificant trend toward higher discontinuation risk. AE incidence was 15.79 per 100 patient-years, and AEs were mostly mild infections and cutaneous reactions. No new safety signals were identified. Conclusion SEC uptitration to 300 mg was associated with sustained improvements in disease activity and favorable retention and safety in axSpA patients with active disease after receiving SEC 150 mg, supporting dose escalation as a clinically effective and safe strategy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".