I'm currently in Ghent, Belgium attending the 10th International Congress on Spondyloarthritides. It's a charming place to listen to world experts discussing science.
Just prior to flying here, I was informed that we'll very soon be able to prescribe Secukinumab in Australia with the medication being heavily subsidised by our government.
This is great news as it gives us another option for treating Ankylosing Spondylitis and Psoriatic Arthritis, spondyloarthritides in which we've only had the option of TNF inhibitor medications as biologic DMARDs until this year.
In psoriatic arthritis, we were allowed the option of prescribing Ustekinumab (an IL12/23 blocker) in May. In rheumatoid arthritis, we have a range of different classes of biologic DMARD medications to choose from.
TNF inhibitor medications have been available for use in ankylosing spondylitis and psoriatic arthritis in Australia since 2004. For those not doing well enough on whichever TNF inhibitor therapy they were using, the options have been to add different conventional oral DMARDs (eg Sulphasalazine or Methotrexate), to add different anti-inflammatory medications (NSAIDs or Cox-2 inhibitors or steroids), to swap between the different TNF inhibitor medications (i.e. swapping within the same class of drugs), or to accept the situation.
Secukinumab works via a different mechanism of action compared to the TNF inhibitors. Secukinumab inhibits IL-17A, and in so doing, it works on blocking the IL23/Th17 pathway that is shown to be really important in spondyloarthritis.
There has been a lot of basic science as well as translational studies being presented at this conference on this IL23/Th17 pathway.
With this knowledge (growing yet incomplete) and with the availability of choice, the obvious question that faces the clinician and the patients we treat:
In spondyloarthritis, should we target IL-17 or TNF inhibition?
Some issues to be considered and/or resolved to help answer this are: