title: Efficacy and safety of intravenous secukinumab in noninfectious uveitis requiring steroid-sparing immunosuppressive therapy.
abstract: OBJECTIVE
  Secukinumab, a fully human anti-interleukin-17A monoclonal antibody, exhibited promising activity in a proof-of-concept study when administered in intravenous (IV) doses to patients with active, chronic, noninfectious uveitis. This study compared the efficacy and safety of different IV and subcutaneous (SC) doses of secukinumab in patients with noninfectious uveitis.
  
  
  METHODS
  Multicenter, randomized, double-masked, dose-ranging, phase 2 clinical trial.
  
  
  METHODS
  Thirty-seven patients with active noninfectious intermediate uveitis, posterior uveitis, or panuveitis who required corticosteroid-sparing immunosuppressive therapy.
  
  
  METHODS
  Patients were randomized to secukinumab 300 mg SC every 2 weeks for 4 doses, secukinumab 10 mg/kg IV every 2 weeks for 4 doses, or secukinumab 30 mg/kg IV every 4 weeks for 2 doses. Intravenous or SC saline was administered to maintain masking. Efficacy was assessed on day 57 (2-4 weeks after last dose).
  
  
  METHODS
  Percentage of patients with treatment response, defined as (1) at least a 2-grade reduction in vitreous haze score or trace or absent vitreous haze in the study eye without an increase in corticosteroid dose and without uveitis worsening or (2) reduction in corticosteroid dosages to prespecified levels without uveitis worsening. Percentage of patients with remission, defined as anterior chamber cell and vitreous haze scores of 0 or 0.5+ in both eyes without corticosteroid therapy or uveitis worsening.
  
  
  RESULTS
  Secukinumab 30 mg/kg IV and 10 mg/kg IV, compared with the 300 mg SC dose, produced higher responder rates (72.7% and 61.5% vs. 33.3%, respectively) and remission rates (27.3% and 38.5% vs. 16.7%, respectively). Statistical and clinical superiority for the 30 mg/kg IV dose compared with the 300 mg SC dose was established in a Bayesian probability model. Other measures, including time to response onset, change in visual acuity, and change in vitreous haze score, showed numeric trends favoring IV dosing. Secukinumab, administered in IV or SC formulations, appeared safe and was well tolerated.
  
  
  CONCLUSIONS
  Intravenous secukinumab was effective and well tolerated in noninfectious uveitis requiring systemic corticosteroid-sparing immunosuppressive therapy. Greater activity with IV dosing suggests that patients may not receive sufficient drug with SC administration. High-dose IV secukinumab may be necessary to deliver secukinumab in therapeutic concentrations.
authors: Corneal Consultants of Colorado, Littleton, Colorado. Electronic address: erikletko@yahoo.com.
authors: Erik
authors: E
authors: Letko
authors: Uveitis and Vasculitis Service, Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
authors: Steven
authors: S
authors: Yeh
authors: Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ocular Immunology and Uveitis Foundation, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors: C Stephen
authors: CS
authors: Foster
authors: Department of Ophthalmology, Charité - University Medicine Berlin, Berlin, Germany.
authors: Uwe
authors: U
authors: Pleyer
authors: Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
authors: Mitchell
authors: M
authors: Brigell
authors: Translational Medicine, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
authors: Cynthia L
authors: CL
authors: Grosskreutz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D061067:Antibodies, Monoclonal, Humanized; D002908:Chronic Disease; D004311:Double-Blind Method; D005128:Eye Diseases / Q000175:diagnosis; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D020381:Interleukin-17 / Q000037:antagonists & inhibitors*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy*; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body / Q000473:pathology; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; C508717:IL17A protein, human; D007166:Immunosuppressive Agents; D020381:Interleukin-17; C555450:secukinumab