Efficacy of secukinumab and adalimumab in patients with psoriatic arthritis and concomitant moderate‐to‐severe plaque psoriasis: results from EXCEED, a randomized, double‐blind head‐to‐head monotherapy study. (1st December 2021)

• Record Type: Journal Article
• Authors: Gottlieb, A.B.; Merola, J.F.; Reich, K.; Behrens, F.; Nash, P.; Griffiths, C.E.M.; Bao, W.; Pellet, P.; Pricop, L.; McInnes, I.B.
• Is Part Of: British journal of dermatology. Volume 185:Number 6(2021)
• Page Start: 1124
• Page End: 1134
• Publication Date: 2021-12-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.20413
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Secukinumab [an interleukin (IL)‐17A inhibitor] has demonstrated significantly higher efficacy vs. etanercept (a tumour necrosis factor inhibitor) and ustekinumab (an IL‐12/23 inhibitor) in patients with moderate‐to‐severe plaque psoriasis. Objectives: To report 52‐week results from a prespecified analysis of patients with active psoriatic arthritis (PsA) having concomitant moderate‐to‐severe plaque psoriasis from the head‐to‐head EXCEED monotherapy study comparing secukinumab with adalimumab. Methods: Patients were randomized to receive secukinumab 300 mg via subcutaneous injection at baseline, week 1–4, and then every 4 weeks until week 48 or adalimumab 40 mg via subcutaneous injection every 2 weeks from baseline until week 50. Assessments in patients with concomitant moderate‐to‐severe psoriasis, defined as having affected body surface area > 10% or Psoriasis Area and Severity Index (PASI) ≥ 10 at baseline, included musculoskeletal, skin and quality‐of‐life outcomes. Missing data were handled using multiple imputation. Results: Of the 853 patients [secukinumab ( N = 426), adalimumab ( N = 427)], 211 (24·7%) had concomitant moderate‐to‐severe psoriasis [secukinumab ( N = 110, 25·8%), adalimumab ( N = 101, 23·7%)]. Up to week 50, 5·5% of patients discontinued secukinumab vs.17·8% in the adalimumab group. The proportion of patients who achieved American College of Rheumatology (ACR) 20 response was 76·4% with secukinumab vs. 68·3% with adalimumab ( P = 0·175), PASI 100 response was 39·1% vs. 23·8% ( P = 0·013), and simultaneous improvement in ACR 50 and PASI 100 response at week 52 was 28·2% vs. 17·7%, respectively ( P = 0·06). Secukinumab demonstrated consistently higher responses vs. adalimumab across skin endpoints. Conclusions: This prespecified analysis in PsA patients with concomitant moderate‐to‐severe plaque psoriasis in the EXCEED study provides further evidence that IL‐17 inhibitors offer a comprehensive biological treatment to manage the concomitant features of psoriasis and PsA.