Secukinumab, Adalimumab Demonstrate Comparable Efficacy in PsA

In patients with psoriatic arthritis (PsA), secukinumab and adalimumab showed similar efficacy, especially regarding time to resolution of enthesitis, according to a study published in Rheumatololgy.¹ Additionally, interleukin-17 (IL-17) reduced clinical enthesitis and was comparable to tumor necrosis factor α (TNF-α) inhibition.

Gurjit S Kaeley, MD

Credit: UF Health Jacksonville

Enthesitis is linked to greater disease activity and reduced quality of life (QoL) and is defined by inflammation of the entheses, in which a tendon or ligament inserts into bone. Clinical enthesitis occurs in approximately 35-50% of patients with PsA and these patients report significantly higher disease burden and greater erosive damage^.2

“This study aims to provide detail on enthesitis treatment response, including temporal response and site-specific enthesitis data along with additional enthesitis assessments, in patients with PsA treated with secukinumab or adalimumab over 52 weeks in EXCEED,” wrote Gurjit S Kaeley, MD, Division of Rheumatology, University of Florida, and colleagues.

Patients with PsA were analyzed for 52 weeks to determine enthesitis treatment response, including time to resolution and data from a variety of enthesitis instruments. The post hoc analysis of the EXCEED study gave patients secukinumab 300 mg or adalimumab 40 mg and were grouped by the prescence or absence of baseline enthesitis based on the Leeds Enthesitis Index (LEI) and the Spondyloarthritis Research Consortium of Canada Enthesitis Index (SPARCC).

Efficacy was determined using several enthesitis-related instruments such as the non-responder imputation for the achievement of enthesitis resolution, (LEI/SPARCC = 0), Kaplan–Meier analysis for time to resolution, and as-observed data for other outcomes.

At baseline, enthesitis at baseline was present in 498 patients (58.5%) as determined by LEI and in 632 (74.1%) of patients determined by SPARCC. Those with baseline enthesitis presented with greater disease activity.

Comparable proportions of patients receiving both drugs adalimumab achieved resolution of LEI and SPARCC at weeks 24 (secukinumab: LEI/SPARCC, 49.6%/45.8%; adalimumab: LEI/SPARCC, 43.6%/43.5%) and 52 (secukinumab: LEI/SPARCC, 60.7%/53.2%; adalimumab: LEI/SPARCC, 55.3%/51.4%) and had comparable mean time to enthesitis resolution. Improvements were similar in both cohorts at enthesitis sites. Resolution of enthesitis with both drugs were linked to improvements in quality of life (QoL) at week 52.

The analyses emphasized the early and sustained resolution of enthesitis through 52 weeks with both adalimumab and secukinumab. Little differences were reported regarding treatment response in both groups. Investigators noted improvements in health-related QoL and patient-reported outcomes with both treatment options; however, they only partially reflect the consequence of improvement or resolution of enthesitis.

“The 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,” investigators concluded. “Our findings suggest that inhibition of IL-17A with secukinumab can result in improvements over 52 weeks in enthesitis responses comparable to those achieved with adalimumab among patients with PsA.”

References

1. ^{Gurjit S Kaeley and others, Enthesitis in patients with psoriatic arthritis treated with secukinumab or adalimumab: a post hoc analysis of the EXCEED study, Rheumatology, 2023;, kead181, https://doi.org/10.1093/rheumatology/kead181}
2. ^{Orbai AM, Birt JA, Holdsworth EA et al.Impact of enthesitis on psoriatic arthritis patient-reported outcomes and physician satisfaction with treatment: data from a multinational patient and physician survey. Rheumatol Ther 2020;7:937–48.}