Abstract
Advances in biologic and targeted synthetic DMARDs have expanded treatment options for spondylarthritis. Despite improvements with TNF inhibitors, many patients remain refractory. Secukinumab, an IL-17A inhibitor, has shown promise in controlled trials. This study evaluates its real-world retention, efficacy, and safety in a Polish cohort. We conducted a retrospective analysis using electronic records from the largest biological treatment center in Poland. Adult patients (≥ 18 years) who initiated secukinumab therapy under the National Health Fund program between November 2018 and October 2024 were included. Primary outcomes were overall drug survival and treatment response at 90 and 180 days. Among 279 patients (139 psoriatic arthritis, 112 ankylosing spondylitis, 28 non-radiographic spondylarthritis; median follow-up 23 months), treatment response rates were 88.2% at 3 months and 88.9% at 6 months, with significant improvements in all evaluated parameters. One-year drug survival was 87%, declining to 59% at 58 months. Dose escalation to 300 mg/month was required in 32.9% of patients, with most (77%) showing subsequent benefit. The risk factor for treatment failure was enthesitis (OR 2.2 95% CI 1.05-4.62), while the factor favoring continuing secukinumab therapy was dactylitis (OR 14.69 95% CI 1.88-114.69). Secukinumab demonstrated robust real-world efficacy, safety, and retention in spondylarthritis patients, supporting its role as an effective treatment.