Axial spondyloarthritis (
axSpA) is an inflammatory rheumatic disorder that causes
chronic pain, primarily in the spine and sacroiliac joints. It is characterized by the presence of type 1 major histocompatibility complex
HLA-B27 genetic marker,
arthritis in peripheral joints, enthesitis and/or dactylitis and extra-articular manifestations. Current guidelines recommend
biological therapy when first-line
therapy is not sufficiently effective. The finding that the
interleukin (IL)-17 axis is vital for the pathogenesis of
axSpA propelled the development of
secukinumab, a fully human
monoclonal antibody directed against
IL-17A. The present review provides evidence on the efficacy and safety of
secukinumab in the treatment of radiographic and non-radiographic
axSpA from nine randomized controlled phase III trials, as well as evidence from real-world observational analyses. The primary endpoint in six clinical trials was the proportion of patients meeting the Assessment of SpondyloArthritis international Society criteria for either 20% or 40% improvement (ASAS20, ASAS40) at week 16. Significantly more patients achieved the primary endpoint with
secukinumab compared with placebo in all the studies except MEASURE 4. Both clinical trials and real-world studies showed significant improvements in the secondary endpoints of disease activity, quality of life, and
pain and
fatigue relative to placebo. The benefits of
secukinumab were generally sustained during longer-term (up to 5 years) treatment. Overall,
secukinumab was well tolerated with a low frequency of adverse events and treatment persistence was high in the real-world setting. Although indirect comparisons suggest that
secukinumab and
adalimumab have comparable efficacy and safety, they are being directly compared in the ongoing SURPASS study. During the current
coronavirus disease 2019 (COVID-19) pandemic, it is advisable to continue
biological therapy in patients who do not have severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)
infection, but interrupt treatment during an
infection, reinitiating once the patient has recovered from the
infection. In conclusion,
secukinumab is a largely safe and effective treatment for radiographic and non-radiographic
axSpA.