How are you taking part in this consultation?

You will not be able to change how you comment later.

You must be signed in to answer questions

  • Question on Consultation

    Has all of the relevant evidence been taken into account?

  • Question on Consultation

    Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence?

  • Question on Consultation

    Are the recommendations sound and a suitable basis for guidance to the NHS?

  • Question on Consultation

    Are there any aspects of the recommendations that need particular consideration to ensure we avoid unlawful discrimination against any group of people on the grounds of race, gender, disability, religion or belief, sexual orientation, age, gender reassignment, pregnancy and maternity?
The content on this page is not current guidance and is only for the purposes of the consultation process.

Secukinumab for treating non-radiographic axial spondyloarthritis

Closed for comments This consultation ended on at   Request commenting lead permission

1 Recommendations

1.1 Secukinumab is recommended as an option for treating active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI, or both) that has responded inadequately to non-steroidal anti-inflammatory drugs (NSAIDs) in adults. It is recommended only if:

  • the disease has responded inadequately to tumour necrosis factor (TNF)-alpha inhibitors, or these are contraindicated or not suitable

  • the company provides secukinumab according to the commercial arrangement (see section 2).

1.2 Assess response to secukinumab after 16 weeks of treatment. Continue treatment only if there is clear evidence of response, defined as:

  • a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and

  • a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more.

1.3 Take into account any communication difficulties, or physical, psychological, sensory or learning disabilities that could affect responses to the BASDAI and spinal pain VAS questionnaires, and make any appropriate adjustments.

1.4 These recommendations are not intended to affect treatment with secukinumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Treatment for non-radiographic axial spondyloarthritis that has not responded to NSAIDs is limited to TNF-alpha inhibitors (adalimumab, certolizumab pegol, etanercept and golimumab). There are no treatment options when people cannot have TNF-alpha inhibitors, or if TNF-alpha inhibitors have not worked well enough.

Clinical trial evidence shows that secukinumab is effective compared with placebo. There are no trials directly comparing secukinumab with TNF-alpha inhibitors. But an indirect comparison suggests that secukinumab may be less effective than TNF‑alpha inhibitors. However, this evidence is uncertain.

Secukinumab is only considered to be a cost-effective use of NHS resources for people who cannot have TNF-alpha inhibitors, or when TNF-alpha inhibitors have not worked well enough. Therefore, it is recommended in these situations.