Secukinumab Improves Abnormal Liver Blood Tests in Spondyloarthritis
Candice Low, Cathie Drislane, Finbar D O’Shea, Richard Conway
Department of Rheumatology, St. Vincent's University Hospital and St. James's Hospital
We monitor for abnormal liver bloods tests in patients treated with biologic agents due to concern over drug induced adverse events. Patients with spondyloarthritis (SpA) frequently have other causes for abnormal liver blood tests including alcohol intake, NSAIDs, and particularly non-alcoholic fatty liver disease (NAFLD).
This was a prospective observational study serially evaluating liver blood tests in consecutive SpA patients with abnormal baseline liver blood tests commencing secukinumab.
Patients with known liver disease with an aetiology other than NAFLD were excluded. Demographic and clinical details were collected on all patients. The primary outcome was the change in alanine aminotransferase (ALT) before secukinumab and 3 months following secukinumab commencement. Wilcoxon Signed Rank Test was used to compare groups as the data was non-parametric. P values <0.05 were assumed as statistically significant throughout.
25 patients (13 psoriatic arthritis (PsA), 12 ankylosing spondylitis (AS)) commenced secukinumab in our institution during the study period. 9 of the 25 (7 PsA, 2 AS) had abnormal baseline ALT and were included in the current study. There was a significant reduction in ALT in SpA patients following secukinumab treatment, median (IQR) 53 (47, 63) vs 42 (28, 50) u/L, p=0.021. PsA patients had a significant reduction in ALT following secukinumab treatment, median (IQR) 53 (50, 64) vs 42 (30, 49) u/L, p=0.018. 3 patients (33%) with increased ALT normalised during the study. There was no significant change in other liver blood tests between the groups.
Secukinumab use was associated with significant improvement in previously abnormal liver blood tests in SpA patients. Secukinumab may represent an attractive treatment option in SpA given the high frequency of liver blood test abnormalities in this patient group.