Vol 8, No 4 (2022)
Review paper
Published online: 2022-12-31

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How to stop radiographic progression. Reimbursement of secukinumab in the B.82 drug program

Dorota Sikorska1, Włodzimierz Samborski1
Rheumatology Forum 2022;8(4):156-162.

Abstract

In the past, axial spondyloarthropathies (axSpA) were considered synonymous with ankylosing spondylitis (AS). However, there is a group of patients who present clinical features of axSpA but do not have radiographic changes. Advances in medicine, especially diagnostic imaging and genetics, have made it possible to diagnose the disease at this earlier stage. For this group of patients, the concept of non-radiographic axSpA has been introduced.
It is already known that for patients with non-radiographic axSpA, as for those with AS, it is crucial to diagnose as soon as possible and initiate effective treatment, which causes the relief of clinical symptoms, but also is to prevent the progression of radiological changes. The introduction of tumor necrosis factor-alpha (TNFα) inhibitors changed the course of the disease and the prognosis of patients with axSpA. However, drugs with other mechanisms of action are being sought. One of the new drugs is secukinumab, which blocks interleukin-17 (IL-17), which is important in the pathogenesis of SpA. It has been shown that the majority of patients with nonradiographic axSpA treated with secukinumab did not show radiological progression.
The role of IL-17 blockade in the therapy of axSpA seems to be more appreciated, which was reflected in the updated global guidelines. Until recently, in Poland, only two drugs with the same mechanism of action — TNFα blockade (certolizumab pegol and etanercept) were reimbursed for patients with non-radiographic axSpA. Fortunately, from July 1, 2022, patients with non-radiographic axSpA can also receive IL-17 inhibitors (ixekizumab and secukinumab) in the B.82 drug program.

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