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April 12, 2026Open Access

Effect of secukinumab dose escalation on MRI-detected inflammation and structural damage in axial spondyloarthritis: a clinical, investigator-initiated, treat-to-target study (TRACE)

Key Points

This study aimed to investigate the effects of secukinumab dose escalation on MRI-detected inflammation and structural damage in patients with axial spondyloarthritis.
Conducted in multiple centers with biologic-naïve patients
Patients escalated from 150 mg to 300 mg based on remission status at week 16
MRI assessments performed at baseline, week 4, week 16, and week 24
Utilized SPARCC and Canada-Denmark scores to evaluate inflammation and structural lesions
Primary endpoint focused on total MRI-inflammation improvement over weeks 16 to 24
35% of patients achieved ASDAS remission at week 16
49% of patients were in remission by week 24, including 22% who responded to dose escalation
Significant reduction in total MRI inflammation was noted at week 4
No statistically significant difference in inflammation reduction between week 16 remitters and non-remitters noted
Dose-escalation responders showed a larger mean reduction in total MRI inflammation than non-responders

Abstract

Introduction Evidence of treat-to-target strategies including secukinumab dose escalation in patients with axial spondyloarthritis (axSpA) remains limited. We investigated the effect of a treat-to-target approach aiming for Axial Spondyloarthritis Disease Activity Score (ASDAS) remission, assessed by clinical and MRI outcomes over 24 weeks. Methods TRACE was a multicentre study including biologic-naïve patients with active axSpA. Sixteen weeks after secukinumab 150 mg initiation, patients in ASDAS remission (<1.3)(week 16 remitters) continued the same dose, while non-remitters (week 16 non-remitters) escalated to 300 mg/month. Sacroiliac joint (SIJ) and spine MRIs were performed at baseline, weeks 4, 16 and 24, and centrally scored using Spondyloarthritis Research Consortium of Canada (SPARCC) and Canada-Denmark scores for inflammation and structural lesions. The primary end point was total MRI-inflammation improvement ≥2 (weeks 16–24) comparing week 16 remitters and week 16 non-remitters. Results Of 90 patients, 68% were male, mean age was 35.4 years. At week 16, 30 (35%) patients achieved ASDAS remission. At week 24, 36 (49%) patients were in ASDAS remission, including 10 (22%) week 16 non-remitters, who responded after dose escalation (dose-escalation responders). Already at week 4, marked reductions in total MRI inflammation (SPARCC spine+SIJ) (–14.7), and structural lesion remodelling (reduced SIJ erosion; increased SIJ fat and backfill), were observed. These changes continued through week 16, with only minor improvements thereafter. The primary end point occurred in 14 (52%) of week 16 remitters versus 19 (41%) of week 16 non-remitters (p=0.53). Dose-escalation responders had a numerically larger mean total MRI inflammation reduction (–6.1) than dose-escalation non-responders (–2.2). Conclusion No statistically significant effect of secukinumab dose escalation on reducing MRI-detected inflammation was observed, except in a selected subgroup of patients. However, 22% achieved ASDAS remission after dose escalation. Notably, substantial MRI-detected inflammation reduction and structural remodelling occurred within the first 4 weeks. Trial registration number NCT03639740 .

Effect of secukinumab dose escalation on MRI-detected inflammation and structural damage in axial spondyloarthritis: a clinical, investigator-initiated, treat-to-target study (TRACE)

Key Points

Abstract

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