Ab0945 assessment of the risk of liver fibrosis in spondyloarthritis treated with secukinumab: a single-center retrospective observational study

Background The prevalence of non-alcoholic steatopathy (NAFLD) is increasing in chronic inflammatory rheumatisms. NAFLD may favor the development of liver fibrosis, which may lead to cirrhosis and its complications including hepatocellular carcinoma. The process of hepatic fibrogenesis involves inflammatory mechanisms with an overexpression of TNF but also of IL 17. Thus, the use of anti-TNF alpha is associated with a decrease in the incidence of hepatic fibrosis. Anti-IL-17 could also have an effect on fibrogenesis but this has not been studied in spondyloarthritis. Objectives The aim of this study was to assess, non-invasively, the risk of liver fibrosis using the FIB-4 score, in patients treated with anti-IL-17. Methods A single-center retrospective observational study was performed. We included all consecutive patients followed between 2015 and 2022 for axial spondyloarthritis (axSpA) meeting the ASAS 2009 criteria or psoriatic arthritis (PsA) meeting the CASPAR criteria, treated for at least 12 months with secukinumab, and for whom at least 12 months of biological follow-up was available. For each patient, we collected demographic data, clinical data, associated treatments, and levels of AST, ALT, platelets at initiation of treatment and after 12 months of treatment. We assessed the FIB-4 score (age(years) * ASAT (U/L))/(platelets (109/L)*√ALAT (U/L))at M0, M12, and M24. Fischer’s exact test was used for comparison between categorical variables and Student’s t test for quantitative variables. Results 38 patients, (20 PsA, 18 axSpA; 60% women in both groups; mean age 57 years in PsA group and 46 years in axSpA group (p<0.01)) were included. The mean disease duration was 10 ± 4 years in the PsA group and 11 ± 5 years in the axSpA group. 78% of axSpA were HLA B27 positive versus 20% of PsA (p<0.01). There was a trend towards a higher prevalence of NAFLD (30% vs. 5%, p=0.09) and previous methotrexate use was more frequent (100% VS 39%, p<0.01) in PsA. The FIB4 score was higher in the PsA group at baseline (1.30 ± 0.24 VS 0.74 ± 0.05; p=0.04). This difference remained significant after 12 months of treatment (1.34 ± 0.25 vs. 0.79 ± 0.06; p=0.048). At M0, no axSpA patient had a FIB4 > 1.3 vs. 6 in the PsA group. At M12, one axSpA patient had a FIB4>1.3 (and <2.0) vs. 6 in the PsA group (including 4 patients with a FIB4>2.0). At M24, one axSpA patient out of 6 had a FIB4>1.3 (and <2.0) versus 3 in the PsA group out of 13 (including 1 patient with FiB4>2.0 and 1 with FiB4<1.3 at inclusion). The overall change in FiB-4 score at 1 year was not different in the PsA and axSpA groups (-0.62 ± 0.25 vs. -0.59 ± 0.27; p=NS). Finally, PsA patients suffer from NAFLD did not worsen their FiB4 score (2.08 ±1.6 at M0 VS 2.02 ± 1.07 at M12; p=NS). Conclusion In PsA and axSpA, 1-year treatment with secukinumab is not associated with an increase in FIB-4 even in patients known to have NAFLD. This study requires confirmation in a larger cohort. Figure 1. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.