Secukinumab Superior to Apremilast, Other Biologics in Psoriatic Arthritis Treatment

Compared with apremilast and other biologic therapies, including targeted synthetic disease-modifying antirheumatic drugs (DMARDs), secukinumab demonstrates good efficacy across multiple outcome criteria in patients with psoriatic arthritis (PsA), according to research results published in the Journal of Comparative Effectiveness Research.

Using data from randomized controlled trials, researchers conducted a network meta-analysis comparing outcomes in PsA in patients treated with secukinumab, apremilast, or other licensed biologic medications.

A systematic literature review identified trials that included approved biologic therapies and targeted synthetic DMARDS to treat active PsA. Specifically, investigators focused on treatment with adalimumab, certolizumab, etanercept, golimumab, infliximab, secukinumab, ustekinumab, and apremilast. Efficacy outcomes included American College of Rheumatology (ACR) 20, 50, and 70 responses, Psoriasis Area Severity Index (PASI) 50, 75, and 90 responses, and Psoriatic Arthritis Response Criteria (PsARC) responses.

A total of 20 clinical trials were included in the analysis; among these, 17 included ACR 20/50/70 responses, 19 included PASI 50/75/90 responses, and 13 included PsARC responses. Study populations were primarily mixed, with some patients who were biologic-naive and others who were biologic-experienced; however, populations in studies with adalimumab, golimumab, and infliximab were entirely biologic-naive.

Investigators noted discrepancies in reported data in trials reporting on patients who were biologic-experienced; these discrepancies centered on trial inclusion criteria, in which some patients receiving treatment may have experienced several previous failures with various tumor necrosis factor inhibitor therapies.

The final treatment network count included 11 studies for ACR criteria, 15 for PASI criteria, and 13 for PsARC criteria.

ACR Networks: Compared with placebo, among the mixed population comprising patients who were biologic-naive and -experienced, investigators identified statistical evidence of “superior ACR20 response at 16 weeks.” Specifically, secukinumab 150 mg and 300 mg demonstrated statistical superiority to both apremilast 20 mg or 30 mg and ustekinumab 45 mg, although infliximab 5 mg/kg, golimumab 50 mg and 100 mg, and adalimumab 40 mg demonstrated statistical superiority compared with both apremilast 20 mg or 30 mg and ustekinumab 45 mg or 90 mg.

Among patients who were biologic-naive, all treatments were superior compared with placebo in terms of ACR response rates; adalimumab and secukinumab 150 mg were superior compared with both doses of apremilast and ustekinumab. In the biologic-experienced group, all treatments except ustekinumab 45 mg and 90 mg were superior compared with placebo.

PASI Networks: In the mixed population, all treatments demonstrated superior PASI 50/75/90 responses. Secukinumab 150 mg or 300 mg was statistically superior to apremilast, certolizumab, adalimumab, and etanercept; also, secukinumab 300 mg was superior to golimumab 50 mg. Infliximab was statistically superior to all treatments except for secukinumab, golimumab, and ustekinumab, and was associated with a slightly higher, but not statistically significant, response rate compared with secukinumab.

In the biologic-naive population, all treatments (secukinumab, adalimumab, golimumab, and infliximab) demonstrated superiority over placebo. Infliximab was found to be statistically superior compared with golimumab and adalimumab. Analyses marginally favored secukinumab over golimumab 50 mg or adalimumab 40 mg.

PsARC Responses: This treatment network included all therapies, except ustekinumab. All treatments demonstrated superiority to placebo, with etanercept and infliximab associated with statistical superiority compared with adalimumab and apremilast. While both certolizumab 200 mg and secukinumab 150 mg were superior to all doses of apremilast, certolizumab 400 mg and secukinumab 300 mg were superior only to apremilast 20 mg and 30 mg.

Among patients who were biologic-naive, adalimumab, etanercept, and infliximab were statistically superior compared with placebo, and infliximab, golimumab, and etanercept were all associated with slightly higher response rates compared with secukinumab.

A study limitation included the fact that certain studies could not be compared pairwise among all individual treatments.

“This [network meta-analysis] is methodologically sound and is the first [network meta-analysis] of all approved PsA therapies to date,” the researchers concluded. “As well as providing comparative evidence, indirect treatment comparisons can generate hypotheses that can be tested in future [randomized control trials]. Head-to-head superiority trials in PsA…will be needed to provide directly comparative results.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

McInnes IB, Nash P, Ritchlin C, et al. Secukinumab for psoriatic arthritis: comparative effectiveness versus licensed biologics/apremilast: a network meta-analysis. J Comp Eff Res. 2018;7(11):1107-1123.