Long-Term Ixekizumab Versus Adalimumab in Psoriatic Arthritis

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In patients with psoriatic arthritis who have not yet been treated with biologic DMARDs, ixekizumab had similar efficacy at one year whether it was used as a monotherapy or in combination with methotrexate or a conventional synthetic (cs) DMARD, while adalimumab showed better efficacy as a combination therapy.

The study was led by Josef Smolen, M.D., of the Medical University of Vienna in Austria, who recently presented the results at the annual meeting of the American College of Rheumatology.

Ixekizumab has been shown to be was superior to adalimumab at 24 weeks follow-up for simultaneous achievement of 50 percent improvement in the American College of Rheumatology (ACR50) score and 100 percent improvement from baseline in the Psoriasis Area and Severity Index (PASI 100) in patients with active psoriatic arthritis who were naïve to biologic DMARDs in the SPIRIT-H2H trial.

In this 566-patient study, the aim was to determine how the safety and efficacy of ixekizumab and adalimumab was affected by concomitant csDMARD (sulfasalazine, cyclosporine, or leflunomide) use through one year in SPIRIT-H2H. Patient subgroups were defined by biologic monotherapy, concomitant methotrexate use and concomitant csDMARD use.

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A greater proportion of patients taking ixekizumab versus adalimumab achieved the primary endpoint or PASI 100 when used as monotherapy or in combination with a csDMARD. However, the proportion of patients achieving ACR50 was not statistically different between ixekizumab and adalimumab, regardless of monotherapy or concomitant csDMARD use. More patients achieved minimal disease activity (MDA) on ixekizumab (49 percent) compared with adalimumab (33 percent) when used as monotherapy, but the response rates were similar in both combination subgroups.

There were no significant differences in safety data across the three subgroups for either ixekizumab or adalimumab.Ixekizumab and adalimumab were well tolerated, with no unexpected safety signals.

In an interview with Rheumatology Network, Dr. Smolen said “ixekizumab has similar efficacy whether it is used as a monotherapy or in combination with methotrexate/csDMARDS, while adalimumab appears to have better efficacy as a combination therapy.”

“Overall, ixekizumab has similar efficacy as adalimumab in terms of musculoskeletal manifestations and better efficacy regarding skin involvement in psoriatic arthritis,” he added.

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REFERENCE

ABSTRACT: 0352.“Efficacy and Safety of Ixekizumab versus Adalimumab with and Without Concomitant Conventional Synthetic Disease-Modifying Antirheumatic Drugs (DMARD) in Biologic DMARD-Naïve Patients with Psoriatic Arthritis: 52-Week Results.”The annual meeting of the American College of Rheumatology. 11:00 AM, Friday, Nov. 6, 2020.