Interplay between COVID-19 and Secukinumab treatment in Spondylarthritis patients during the omicron surge: a retrospective cohort study

Abstract

The objective of this retrospective cohort study was to assess the relationship between Corona Disease 2019 (COVID-19) and Secukinumab treatment in patients with Spondylarthritis (SpA) in China during the omicron surge. Researchers retrieved 1018 medical records of Secukinumab-treated patients between January 2020 and January 2023 from the West China Hospital of Sichuan University. Out of these, 190 SpA patients from the rheumatology clinic were selected for the study. Guided phone questionnaires were administered by research staff to collect baseline characteristics, SpA disease status, and COVID-19 clinical outcomes. Cohabitants served as the control group and provided COVID-19 related data. Of the 190 potential SpA patients, 122 (66%) completed the questionnaire via phone, along with 259 cohabitants. 84.4% of SpA patients were diagnosed with Ankylosing Spondylitis (AS), and 15.6% were diagnosed with Psoriatic Arthritis (PsA). The rate of SARS-CoV-2 infection was 83.6% in the Secukinumab group and 88.8% in the cohabitants control group, with no significant difference (OR = 0.684, CI 0.366–1.275). One instance of severe COVID-19 was observed in the Secukinumab group, while two were identified in the cohabitants control group. Patients in the Secukinumab group had less time with fever caused by COVID-19 (p = 0.004). Discontinuing Secukinumab after SARS-CoV-2 infection did not significantly affect the course of COVID-19 or worsen SpA status according to our data. Our study suggests that administering Secukinumab to SpA patients does not increase their susceptibility to contracting SARS-CoV-2, and may have a positive effect on the course of SARS-CoV-2 infection.

Keywords:

• Covid-19
• SARS-CoV-2
• spondylarthritis
• IL-17 inhibitors
• secukinumab

Introduction

The Coronavirus Disease-19 (COVID-19), caused by infection with SARS-CoV-2, is a respiratory disease that was first detected in Wuhan, China in December 2019, and has since become a pandemic [1,2]. T The COVID-19 pandemic has raised concerns in patients with immune-mediated inflammatory diseases (IMIDs), including spondylarthritis (SpA), especially when they are receiving immunosuppressive therapy and in a state of intrinsic immune system dysregulation [3].

Once SARS-CoV-2 enters respiratory epithelial cells, it triggers an immune response with inflammatory cytokine production known as a cytokine storm, which is considered to be the primary cause of disease severity and death in COVID-19 patients [4,5]. Among the multifunctional cytokine family, interleukin-17 (IL-17) is a predominant member involved in pulmonary inflammation. Thus, some clinicians argue that targeting IL-17 is a plausible strategy to prevent acute respiratory distress syndrome (ARDS) in COVID-19 [6,7].

During the last few decades, IL-17 inhibitors (such as Secukinumab, Ixekizumab, and Brodalumab) have been adopted for the treatment of psoriasis and SpA [8–10]. Secukinumab is a fully recombinant human immunoglobulin G (IgG)1 kappa monoclonal antibody (mAb) that directly inhibits IL-17A. Notably, it is the first approved IL-17 inhibitor for treating ankylosing spondylitis patients [11]. Although Secukinumab has been demonstrated to be effective in the treatment of SpA, studies have suggested that its use may increase the risk of non-severe infections, with upper respiratory tract infections and nasopharyngitis being the most reported [8,12]. As a result, there has been a growing concern regarding the potential impact of Secukinumab on the immune response to COVID-19 in patients with SpA.

It is important for clinicians to carefully weigh the potential risks and benefits of continuing or discontinuing IL-17 inhibitors in patients with SpA during the COVID-19 pandemic. However, the available evidence on the relationship between IL-17 inhibitors and COVID-19 in this patient population remains scarce and inconsistent. Therefore, we performed this retrospective cohort study aimed to assess the interplay between COVID-19 and SpA patients receiving IL-17 inhibitor (Secukinumab) treatment in China during the omicron surge.

Materials and methods

Study design

This cohort study was conducted at West China Hospital of the Sichuan University and approved by the ethics committee of West China Hospital 2023(277). Researchers contacted participants by telephone, explained the study in detail and obtained consent from those who agreed to participate. Participants completed the designed questionnaire over the phone with guidance from research staff.

Participants

We retrieved medical records of patients including the keywords “Secukinumab,” “Cosentyx” or “Interleukin 17 inhibitors” from Biomedical Big Data Centre, West China Hospital of the Sichuan University. After eliminating duplicate hospital registration numbers, we conducted a thorough review of patients’ electronic medical records to identify individuals who met the following inclusion criteria: 1) From January 2020 to January 2023, patients have medical records of visits to the Rheumatology and Immunology Department at West China Hospital, Sichuan University; 2) Patients have a confirmed diagnosis of spondylarthritis for at least 3 months based on the Assessment of SpondyloArthritis international Society (ASAS) criteria for axial SpA [13]; 3) Patients have received Secukinumab treatment for at least one month prior to SARS-CoV-2 infection; 4) Patients should be over 18 years of age. Exclusion criteria for the study were pregnancy, history of prior or concomitant malignancies, and communicable diseases such as HIV, tuberculosis, and hepatitis. Patients with coexisting rheumatic diseases, including rheumatoid arthritis and systemic lupus erythematosus, were also excluded from the study.

In addition, we collected COVID-19-related data from cohabitants of the SpA patients. Cohabitants were defined as individuals who shared a living space such as a household or residence with a SpA patient for at least one month before and after SARS-CoV-2 infection, but had not received Secukinumab treatment. These cohabitants were included in the study as a control group.

Interview process and data collection

Participants were contacted by telephone and guided by a rheumatologist to complete the questionnaire. To ensure data quality, the questionnaire data was reviewed by two physicians as part of a quality control process. Interviews were conducted between January 15 and January 22, 2023. The questionnaire consisted of three parts: the first part collected sociodemographic, clinical, treatment, and disease course data for spondyloarthropathy; the second part collected data on COVID-19 clinical outcomes; and the third part collected COVID-19 related data for cohabitants (See the questionnaire form in Supplementary Table 1).

The severity status of SpA was determined based on patients’ reported outcomes, with patients classified as either stable or experiencing exacerbation. Exacerbation of the disease was defined as the presence of at least one of the following symptoms: increased spinal or joint pain, aggravated or new onset joint swelling, longer duration of morning stiffness, and aggravated or new onset of peripheral symptoms.

Confirmed COVID-19 was defined as a positive SARSCoV-2 PCR test using nasopharyngeal swabbing and/or a positive antibody test. High suspicion for COVID-19 was defined in accordance with CDC guidelines as any patient with new fever >99 °F or a known positive contact plus one or more respiratory symptoms (dry cough, anosmia, sore throat, or shortness of breath) that could not be confirmed given the initial limited availability of SARS-CoV-2 PCR or antibody testing in Cheng Du at the time of this study [14].

Statistical analysis

IBM SPSS (Armonk, New York, United States: IBM Corp) version 26.0 was used to perform statistical analyses. Descriptive statistics are reported as mean (standard deviation) for continuous variables and as number and frequencies for binary and categorical variables. The comparison of these variables was conducted with Mann-Whitney U test for continuous variables, as the data distribution was non-parametric. Chi-square test was used for categorical variables. The chi-square test was also performed to compare presence of COVID-19, symptoms, and the course of the disease between the Secukinumab and control groups.

Results

Study sample and baseline characteristics

A total of 1018 medical records of patients were retrieved from Biomedical Big Data Centre, West China Hospital of the Sichuan University. After eliminating duplicate hospital registration numbers, we identified 572 patients whose medical records contained pertinent information regarding the usage of Secukinumab. Among these, 272 patients were excluded due to the absence of medical records indicating a visit to the Rheumatology and Immunology Department between January 2020 and January 2023, while an additional 66 patients were excluded as they had ceased Secukinumab treatment during their care at the Rheumatology and Immunology Department. Among the remaining 234 patients, 190 individuals with SpA were identified following a thorough review of electronic medical records. Of these 190 patients, a total of 126 (66%) completed the questionnaire via phone, and 122 SpA patients were ultimately included in this study. Four patients were excluded because they initiated Secukinumab treatment after their SARS-CoV-2 infection (Figure 1).

Figure 1. Flowchart for patient selection.

The baseline clinical characteristics are presented in Table 1. Among the respondents, 103 (84.4%) were diagnosed with Ankylosing spondylitis (AS) and 19 (15.6%) were diagnosed with Psoriatic arthritis (PsA). Overall, the average age of the study participants was 36 years, with an average disease duration of 5.36 years. On average, IL-17 inhibitors were used for 0.74 years. Of those with comorbidities, the most reported were hypertension (5.7%). Approximately half of the patients in the cohort used Secukinumab without concomitant use of any rheumatologic medication. Of the 43 patients (35.2%) who were concurrently taking conventional synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs), 38 used sulfasalazine (SSZ), 5 PsA patients used Methotrexate (MTX), and only one PsA patient used Leflunomide. The utilisation of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) was comparatively greater in patients with AS as opposed to those with psoriatic arthritis PsA. In addition, baseline GC use was reported in only 1.6% of the patients. Compared with PsA patients, AS patients had a significantly higher prevalence of male patients than female patients, with a male-to-female ratio of about 3:1, which is consistent with the epidemiological characteristics of the disease. Other than that, there were no significant differences in baseline characteristics across disease groups.

Table 1. Comparison of baseline characteristics, medication use, and disease course in as and PsA patients.

Characteristic	Total (n = 122)	AS (n = 103)	PsA (n = 19)	p-value
Age-mean (SD)	36.23 (11.41)	35.52 (11.05)	41.10 (13.59)	0.143
Sex-n (%)
Female	39 (32.0)	29 (28.2)	10 (52.6)	0.036 *
Male	83 (68.0)	74 (71.8)	9 (47.4)
BMI-mean (SD)	23.02 (3.26)	22.84 (3.28)	23.78 (2.99)	0.247
Smoking-n (%)	34 (27.6)	27 (26.2)	6 (31.6)	0.629
Disease duration (year)-mean (SD)	5.36 (6.10)	5.38 (6.27)	5.49 (5.39)	0.944
IL-17 treatment duration (year)-mean (SD)	0.74 (0.62)	0.70 (0.59)	0.95 (0.79)	0.11
Comorbidities-n (%)
No comorbidity	108 (88.5)	92 (89.3)	16 (84.2)	0.802
Diabetes mellitus	3 (2.5)	2 (1.9)	1 (5.3)	0.401
Hypertension	7 (5.7)	6 (5.8)	1 (5.3)	1
Cardiovascular disease	2 (1.6)	2 (1.9)	0	1
Chronic obstructive pulmonary disease/asthma/interstitial lung disease	2 (1.6)	1 (1.0)	1 (5.3)	0.288
Liver cirrhosis	2 (1.6)	1 (1.0)	1 (5.3)	0.288
Oral Rheumatologic medications-n (%)
No oral medications	63 (51.6)	52 (50.5)	11 (57.9)	0.553
csDMARDs	43 (35.2)	36 (35.0)	7 (36.8)	0.874
SSZ	38 (31.1)	36 (35.0)	2 (10.5)	<0.0001 *
MTX	5 (4.1)	0	5 (26.3)	<0.0001 *
Leflunomide	1 (0.8)	0	1 (5.3)	0.163
NSAIDs	67 (54.9)	45 (43.7)	2 (10.5)	0.006 *
GCs	2 (1.6)	1 (1.0)	1 (5.3)	0.288

IL-17 inhibition usage and COVID-19

To determine whether the use of Secukinumab affects the likelihood of developing COVID-19, we used cohabitants of SPA patients who did not receive IL-17 inhibitors as a control group and conducted a comparative analysis between the two groups. A cohort comprising 122 individuals who were administered Secukinumab and 259 cohabitants were included in the study. The overall rate of SARS-CoV-2 infection (including both confirmed and high suspicion COVID-19) in our SpA cohort was 83.6% and 88.8% in control group, and no significant difference between the Secukinumab group and controls was observed (OR = 0.684, CI 0.366–1.275) (Table 2). All patients who tested positive for SARS-CoV-2 were infected in December 2022, when the Omicron variant was prevalent in China.

Table 2. Comparison of SARS-CoV-2 infection rate and COVID-19 outcomes in Secukinumab and cohabitants control group.

	Secukinumab Group (n = 122)	Cohabitants control Group (n = 259)	p-value
COVID-19-n (%)	103 (84.4)	230 (88.8)	0.23
SARS-CoV-2 infection positive	73 (59.8)	165 (63.7)	0.872
SARS-CoV-2 infection high suspicion	30 (24.6)	65 (25.1)
COVID-19	N = 103	N = 170
Age-mean	36.78 (10.26)	38.84 (9.55)	0.094
Sex-n (%)
Female	36 (35)	84 (50.6)	0.024*
Male	67 (67)	86 (49.4)
Covid-19 vaccine doses
No	23 (22.3)	15 (8.8)	0.003*
yes	80 (77.7)	155 (91.2)
1 dose	7 (6.8)	2 (1.2)	0.030*
2 doses	24 (23.3)	34 (20)	0.544
3 doses	47 (45.6)	118 (69.4)	<0.0001*
4 doses	2 (1.9)	1 (0.6)	0.559
Comorbidities-n (%)
No	90 (87.4)	151 (89.9)	0.553
Yes	13 (12.6)	17 (10.1)
COVID-19 Symptoms-n (%)
Asymptomatic	1 (1.0)	2 (1.2))	>0.9999
Fever	81 (78.6)	138 (81.2)	0.640
Cough/sputum	66 (64.1)	132 (77.6)	0.018*
Sore throat	42 (40.8)	87 (51.2)	0.105
Myalgia/weakness	54 (52.4)	71 (41.8)	0.103
Duration of fever-mean (SD)	1.79 (1.24)	2.23 (1.42)	0.013*
Classification of fever-n (%)	n = 71	n = 132
Low grade (37.3 ∼ 38 °C)	17 (21.0)	20 (15.2)	0.131
Moderate grade (38 ∼ 39 °C)	36 (44.44)	82 (62.1)	0.136
High grade (39 ∼ 41 °C)	18 (17.4)	30 (22.7)	0.730
Classification of COVID-19-n (%)
Mild	9 (8.7)	16 (9.4)	>0.9999
Moderate	93 (90.3)	152 (89.4)	>0.9999
Severe	1 (1.0)	2 (1.2)	>0.9999
Hospitalisation-n (%)	2 (1.9)	3 (1.8)	>0.9999

To investigate intergroup differences in clinical characteristics related to COVID-19, we conducted a statistical analysis on two age-matched groups of COVID-19-positive individuals. No disparities in comorbidities were identified between the two groups. In terms of COVID-19 vaccine administration, the control group exhibited a significantly higher vaccination rate compared to the Secukinumab group (91.2% VS 77.7%, p = 0.003). This difference was primarily observed in individuals who received full three-dose regimen, with 69.4% in the control group and 45.6% in the Secukinumab group (p = 0.0001). We also observed a statistically significant difference on the number of days with fever between the Secukinumab group and controls in favour of the Secukinumab group (1.79 ± 1.24 VS 2.23 ± 1.42, p = 0.013). Besides, neither the level of fever nor the severity classification of COVID-19 was different between the two groups. We further analysed the COVID-19 symptoms of participants, with fever being the most common, followed by cough and myalgia. Since there were very few COVID-19 hospitalised patients in both groups (1.9% VS 1.8%), we were unable to determine the impact of IL-17 inhibitor use on COVID-19 hospitalisation rates.

After conducting the questionnaire survey, we discovered that a portion of patients ceased their use of Secukinumab following their contraction of COVID-19. To better understand the effects of discontinuing Secukinumab on COVID-19 development, we partitioned patients into two distinct groups: a "discontinued" group and an "ongoing" group for analysis. Our analysis revealed no significant differences in terms of the number of fever days, fever intensity, and COVID-19 classification between the two groups (Supplementary Table 2). Interestingly, we found that patients in the discontinued group had undergone IL-17 inhibitor treatment for a significantly longer duration compared to those in the ongoing group (2.3 ± 1.15 VS 0.76 ± 0.63, p < 0.0001).

SpA disease status during COVID-19

While administering our questionnaires, we observed that certain patients experienced an exacerbation of SpA following infection with SARS-CoV-2. Among them, 48% reported an increased spinal or joint pain, 35% reported a new onset of uveitis and 17% reported a longer duration of morning stiffness. Consequently, we conducted further analyses to explore potential risk factors that may be associated with the progression of SpA (Table 3). The proportion of individuals taking medications to treat COVID-19 was similar in both groups (87% VS 90%). However, in comparison to the exacerbation Group group, patients in the stable group exhibited a significantly higher ratio of NSAIDs medication usage to alleviate symptoms (34.8% VS 65.0%, p = 0.0154). Additionally, we found that the disease duration of SpA was a significant factor in the exacerbation. Patients with a longer disease duration are less prone to experiencing a deterioration in their condition (p = 0.035).

Table 3. Comparison of characteristics, medication use, disease course and COVID-19 outcomes in exacerbation group and stable group.

	Exacerbation Group (n = 23)	Stable Group (n = 80)	p-value
Rheumatic disease diagnosis-n (%)
AS	20 (87.0)	66 (82.5)	0.757
PsA	3 (13.0)	14 (16.5)
Age-mean (SD)	39.29 (9.220)	35.71 (11.332)	0.195
BMI-mean (SD)	23.23 (2.980)	23.14 (3.760)	0.915
Smoking-n (%)	4	24
Disease duration (year)-median (quartile)	1.5 (1.0,3.0)	1.5 (1.0,10.0)	0.035*
IL-17 treatment duration (year)-median (quartile)	0.75 (0.33,1.0)	0.5 (0.25,1.0)	0.628
Secukinumab dosage-n (%)
150mg/month	18 (78.3)	62 (77.5)	0.938
300mg/month	3 (13.0)	10 (12.5)	1
150mg/2 months	0	1 (1.3)	1
600mg/month	2 (8.7)	5 (6.3)	0.651
1200mg/month	0	2 (2.5)	1
Covid-19 vaccine-n (%)
0	5 (21.7)	18 (22.5)	0.938
1 dose	2 (8.7)	5 (6.3)	0.651
2 doses	7 (30.4)	17 (21.3)	0.358
3 doses	9 (39.1)	38 (47.5)	0.478
4 doses	0	2 (2.5)	1
Oral medications for COVID-19
NO	3 (13.0)	8 (10.0)	0.706
Yes	20 (87.0)	72 (90.0)
Antivirals	1 (4.3)	1 (1.3)	0.398
NSAIDs	8 (34.8)	52 (65.0)	0.015*
Compound cold medicine	3 (13.0)	5 (6.3)	0.373
Chinese patent drug	12 (52.2)	29 (36.3)	0.227
Antibiotics	0	3 (3.8)	>0.9999
Duration of Fever-mean (SD)	1.78 (1.565)	1.64 (1.193)	0.634
Discontinued Secukinumab usage-n (%)	9 (39.1)	24 (30.0)	0.408
Pre-exist oral rheumatologic medication-n (%)	15 (65.2)	35 (43.8)	0.069
Classification of COVID-19-n (%)
Mild	2 (8.7)	7 (8.8)	1
Moderate	21 (91.3)	72 (90.0)	0.852
Severe	0	1 (1.3)	1

Discussion

Despite existing studies on COVID-19 in patients with IMIDs, a research gap persists in investigating the impact of COVID-19 specifically on patients with SpA and the effect of IL-17 inhibitors on COVID-19 course in SpA patients [15]. Our study aimed to address these gaps by examining the impact of Secukinumab on COVID-19 susceptibility and outcomes in SpA patients, including the safety and efficacy of continued biologic use after infection. Our findings provide valuable insights into these important clinical questions.

Our study revealed that the pre-existing use of Secukinumab did not increase the risk of SARS-CoV-2 infection or exacerbate the course of COVID-19 in patients with SpA. Discontinuing the treatment after COVID-19 diagnosis did not appear to worsen the clinical outcomes either. These results are in line with previous findings on the interplay between COVID-19 and SpA [16–18]. Among the COVID-19-positive population, patients in the Secukinumab group exhibited a significantly reduced overall vaccination rate compared to the cohabitants control group. Specifically, the Secukinumab group had a higher proportion of individuals who received a single vaccine dose, whereas the percentage of those who completed the full three-dose regimen was lower. Patients undergoing IL-17 inhibitor therapy for SpA are immunocompromised, potentially resulting in diminished immune responses and decreased protective efficacy following vaccination. In line with the COVID-19 vaccination guidelines (First Edition) issued by the Chinese Centre for Disease Control and Prevention, it is recommended to fully inform patients of the risks and benefits and allow them to make an informed decision on vaccination [19]. Consequently, SpA patients may, based on their individual disease and immune status, tend to opt for a more conservative approach that might involve reducing the number of vaccine doses.

Moreover, we observed a shorter duration of fever in the Secukinumab group compared to the control group, which implies that Secukinumab may have a positive effect on the course of SARS-CoV-2 infection in SpA patients. Notably, similar positive outcomes with COVID-19 in patients treated with IL-17 Inhibitors (Secukinumab and Ixekizumab) have been reported by other researchers [20,21]. The potential mechanism by which Secukinumab may improve COVID-19 outcomes is through its ability to block IL-17A and mitigate the inflammation associated with the infection. In a murine model of lipopolysaccharide (LPS)-induced acute lung injury (ALI), administration of anti-IL-17 antibodies resulted in enhanced survival, reduced lung infiltration, and improved lung pathology scores. Indeed, previous studies have shown that high levels of IL-17 and other pro-inflammatory cytokines produced by T helper 17 (TH-17) cells are associated with severe COVID-19 [22]. Moreover, Mugheddu et al. [23] found that secukinumab could be safely treat severe COVID-19 patients and shorten their disease course.

Our study also revealed an interesting observation, whereby SpA patients who discontinued Secukinumab had a longer treatment duration compared to those who continued. Prior studies have demonstrated that Secukinumab can sustain improvements in Assessment of SpondyloArthritis international Society 20 (ASAS20) response rates and other significant efficacy endpoints for a period of 3–5 years [8,24,25]. Based on the above clinical findings, we hypothesise that Secukinumab’s ability to maintain patients’ disease status for an extended duration may account for the observed phenomenon. Consequently, patients have expressed greater concern regarding the potential negative effects of Secukinumab on COVID-19 outcomes, in comparison to discontinuing biologics and its impact on their SpA condition. Overall, our findings suggest that discontinuing Secukinumab during SARS-CoV-2 infection may not be necessary and reinforcing the potential benefits of IL-17 inhibitors in ameliorating the clinical course of COVID-19.

We also observed that some SpA patients experienced exacerbation of their condition following SARS-CoV-2 infection. Our analysis, however, did not reveal any disparities in terms of COVID-19 vaccination, fever caused by COVID-19, or the use of IL-17 inhibitors between the exacerbation and stable groups. However, we observed a disparity between the two groups in the proportion of medications used for treating COVID-19. The use of NSAIDs, such as Ibuprofen, for alleviating COVID-19 symptoms may be more favourable for SpA patients in maintaining the stability of their underlying condition. This observation could be attributed to the potential therapeutic effects of NSAIDs on SpA. NSAIDs are recommended as the first-line drug therapy of patients with axial spondyloarthritis (axSpA) [26]. Existing evidence supports the efficacy of NSAIDs in relieving pain and stiffness in axSpA patients, both in the short-term and during extended treatment periods [27,28]. Furthermore, our findings suggest that disease duration was a significant factor in the progression of the disease, as longer disease duration was associated with a lower risk of exacerbation. This could be due to the development of adaptive mechanisms by the immune system over time, resulting in a less severe immune response to the disease. Previous studies have proved that disease duration was negatively correlated with disease activity, which may be due to a combination of treatment effects and natural disease course [29,30].

The key strength of our study is the use of cohabitants of SpA patients as non-IL-17 inhibitors controls, which has rarely been done in previous studies. This approach enabled us to to perform a comparison of SARS-CoV-2 infection rates and associated indicators between patients receiving Secukinumab and a control group cohabiting with them. This strategy effectively mitigated the influence of extraneous variables, including household transmission and socioeconomic status, thereby providing a more accurate assessment of the impact of Secukinumab on SARS-CoV-2 infection in SpA patients. Another strength of our study is that we went beyond investigating the impact of IL-17 inhibitors use on COVID-19 disease course in SpA patients, and analysed the effect of discontinuing Secukinumab treatment on both COVID-19 disease course and the status of SpA. Our findings provide valuable insights into the complex relationship between IL-17 inhibitors, COVID-19, and spondyloarthritis, and could help inform clinical decision-making in the treatment of SpA patients during the ongoing pandemic.

While our study provided valuable insights into the impact of IL-17 use on COVID-19 outcomes in SpA patients, there are several limitations that should be considered. Firstly, the potential for recall bias is a major concern as all data were collected through telephone questionnaires and self-reporting by patients, which may introduce measurement errors and limit the accuracy of the data. Furthermore, when we conducted this study, the Omicron variant was the prevailing strain of the virus circulating in China. Despite a high number of infections, more than 90% of cases were either asymptomatic or mild, and the rates of severe illness and mortality were extremely low. Thus, we are unable to analyse the relationship between Secukinumab usage and COVID-19 hospitalisation in SpA patients. Another limitation is that our study is a single-centre study in China and included patients from a particular socioeconomic and cultural background. Although it may not be generalised to all SpA patients, it reflects our patient population.

Conclusions

Overall, our findings suggest that SpA patients can safely receive Secukinumab treatment during the COVID-19 pandemic, and that discontinuing treatment following COVID-19 diagnosis may not necessarily lead to worse outcomes. Further studies are necessary to validate our findings and investigate the long-term effects of IL-17 inhibitors treatment on SARS-CoV-2 infection and disease progression in SpA patients. In addition, the prevention or improvement of COVID-19 outcomes with immunomodulatory medications remains a subject of ongoing research.

Disclosure statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Additional information

Funding

This work was supported by the Sichuan Province Science and Technology Support Program [Project No. 2021YFS0166], 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University [Grant Number: ZYGD18015, ZYJC18003].