Secukinumab and adalimumab have similar efficacy in the treatment of enthesitis in psoriatic arthritis (PsA), according to study findings published in Rheumatology.
Up to 50% of patients with PsA experience enthesitis, which is associated with higher disease burden and greater erosive damage.
In a post hoc analysis, researchers evaluated data from the EXCEED trial (ClinicalTrials.gov Identifier: NCT02745080), a multicenter, randomized, double-blind, head-to-head, active-control study comparing the efficacy of secukinumab and adalimumab among patients with PsA.
Patients with SLE were randomly assigned 1:1 to receive 300 mg secukinumab or 40 mg adalimumab for 52 weeks. Patients were stratified by the presence of enthesitis, defined using the Leeds Enthesitis Index (LEI) and Spondylarthritis Research Consortium of Canada Enthesitis Index (SPARCC).
The primary study outcomes were the median time to enthesitis resolution and change in LEI and SPARCC scores at weeks 24 and 52.
A total of 853 patients were included in the current analysis, of whom 426 received secukinumab and 427 received adalimumab.
According to the LEI, 58.5% of patients had enthesitis and according to the SPARCC, 74.1% had enthesitis. Patients with and without enthesitis were well balanced, except that more women had enthesitis than men and patients with vs without enthesitis had greater disease activity, higher tender joint counts, higher pain scores and Psoriasis Area and Severity Index (PASI) scores, and worse physical function.
At week 24, patients with enthesitis who received secukinumab had a decrease in LEI score of -1.6 (SD, 1.6) points and SPARCC score of -3.3 (SD, 3.5) points and those who received adalimumab had improvements of -1.6 (SD, 1.6) and -3.1 (SD, 3.5) points, respectively. The overall mean change in LEI scores were -1.8 and -2.1 points and SPARCC scores were -3.6 and -3.9 points for secukinumab and adalimumab, respectively.
A similar percentage of recipients of secukinumab and adalimumab achieved LEI (60.7% vs 55.3%) and SPARCC (53.2% vs 51.4%) resolution at week 52, respectively.
The median time to LEI resolution was 85 days for both the secukinumab and adalimumab cohorts and the time to SPARCC resolution was 113 days for secukinumab and 88 days adalimumab. Overall, patients with more involved joints at baseline had a longer time to resolution.
Few relapse events were observed in the study and none of the patients developed enthesitis.
No evidence of site-specific enthesitis resolution differences were observed.
Both secukinumab and adalimumab groups were associated with similar improvements in health-related quality of life outcomes, and greater improvements were reported by patients who achieved enthesitis resolution.
Study limitations included the post hoc design and the fact that in the main EXCEED analysis, the primary efficacy outcome was not met.
“[T]he findings from this study indicate that secukinumab and adalimumab improve enthesitis among patients with PsA to a similar extent in terms of achievement of enthesitis resolution, timing of response, site-specific responses, and occurrence of relapse after first resolution,” the study authors concluded.
Disclosures: This research was supported by Novartis Pharmaceuticals Corporation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Kaeley GS, Schett G, Congahan PG, et al. Enthesitis in patients with psoriatic arthritis treated with secukinumab or adalimumab: a post hoc analysis of the EXCEED study. Rheumatology. Published online April 25, 2023. doi:10.1093/rheumatology/kead181