Older Age, Male Sex Linked to More Severe COVID-19 Outcomes in Rheumatology Patients Treated With Secukinumab

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Patients with ankylosing spondylitis generally had more favorable outcomes compared to those with psoriasis or psoriatic arthritis.

Patients treated with secukinumab are not at an increased risk of more severe COVID-19 outcomes in patients with rheumatologic diseases.

A team, led by Atul Deodhar, Oregon Health & Science University, analyzed COVID-19 outcomes for patients with psoriasis, psoriatic arthritis, or ankylosing spondylitis treated with secukinumab.

What is Known

Patients with immune-mediated inflammatory diseases being treated with immunosuppressive therapies are not at a greater SARS-CoV-2 infection risk. However, the reported risk of severe outcomes or sequalae can vary from study to study. There is also a lack of data regarding patients treated with secukinumab.

In the study, presented during the 2022 American College of Rheumatology (ACR) Convergence Meeting in Philadelphia, the investigators searched the Novartis global safety database for cases reporting COVID-19 in patients being treated with secukinumab from clinical trials or post-marketing surveillance between December 2019 and February 2022.

The team examined potential associations between subgroups, including age, sex, and treatment indication and COVID-19 severity or outcomes using Chi-squared testing.

The Trials

Only a handful of clinical trials involving patients treated with secukinumab were ongoing and identifying, resulting in only 8 COVID-19 cases.

However, all of these cases resulted in hospitalization, none of which were suspected to be related to the secukinumab. Seven of the patients recovered completely and 1 recovered with sequalae.

Post-Marketing Surveillance

Looking at the post-marketing surveillance, the investigators identified 2948 COVID-19 cases (PsO: n = 1126; PsA: n = 942; AS: n = 469). In this analysis, the investigators found a higher proportion of patients with ankylosing spondylitis were younger (43% younger than 45 years) compared to patients with psoriatic arthritis or psoriasis.

The data also show that older age and the male sex were both associated with increased COVID-19 severity (P <0.0001 and P = 0.0001, respectively).

Moreover, patients with ankylosing spondylitis were less likely to have severe COVID-19 cases compared to patients with psoriasis or psoriatic arthritis (PsO: n = 363, 32.2%; vs PsA: n = 257, 27.3%; vs AS: n = 107, 22.8%). This might be explained by a younger age in the ankylosing spondylitis group.

In this analysis, 27.5% of cases had a complete recovery, while 1.6% were fatal and 52.3% had unknown outcomes. Once again, older patients and males suffered worse COVID-19 outcomes (P <0.0001 and P = 0.0183, respectively). There were fewer patients in the ankylosing spondylitis group that had a fatal outcome than the other 2 groups (PsO: n = 18, 1.6%; vs PsA: n = 14, 1.5% vs AS: n = 4, 0.9%).

However, fewer patients with ankylosing spondylitis made a complete recovery (PsO: n = 390, 34.6% vs PsA: n = 258, 27.4% vs AS: n = 114, 24.3%).

“This exploratory analysis reports COVID-19 cases in the Novartis global safety database for more than 2 years since the onset of the pandemic,” the authors wrote. “Rates of hospitalization and death from COVID-19 in pts receiving secukinumab were generally in line with reports in immune-mediated inflammatory diseases and overall population. Consistent with published data, older age and male sex had negative impact on both the seriousness and outcome of COVID-19. Potential associations with underlying disease state warrant further investigation.”

The study, “COVID-19 Cases in Patients Treated with Secukinumab: Analysis from the Global Safety Database,” was published online by ACR Convergence 2022.