Objectives: Secukinumab (SEC) has European approval for the treatment of active psoriatic arthritis (PsA) in adults who had inadequate response to previous disease-modifying anti-rheumatic drug (DMARD) therapy. Psoriatic Arthritis Response Criteria (PsARC) responses are useful for economic modelling, although clinical utility is limited. As no trials directly compare SEC against biologics, we used network meta-analysis (NMA) to compare short-term differences in PsARC response. Methods: A systematic literature review (November 2015) identified randomised controlled trials of licensed biologics in adults with active PsA who had failed conventional DMARD therapy. Twelve trials were identified for the PsARC network. An NMA was developed in accordance with health technology assessment guidance using a Bayesian random effects model. Because of differences in placebo response across trials, which could bias the NMA, placebo adjustments were considered. Deviance information criteria were similar but leverage plots suggested a better fit with placebo adjustment. Results at 12-16 weeks are presented as probability of response (95% credible interval [CrI]) and relative risk (RR) (CrI) from pairwise comparison for the placebo-adjusted model. Results: In the mixed population of biologic-naïve and experienced patients, SEC 150 mg QM (79.6% [52-94], RR, 1.81 [1.18-2.38]) and SEC 300 mg QM (82.8% [47-97], RR, 1.88 [1.07-2.48]) were statistically significantly superior to apremilast (APR) 20 mg BID, and SEC 150 mg was statistically significantly superior to APR 30 mg BID (RR, 1.50 [1.04-1.97]). There was no statistically significant difference between either SEC dose and APR 40 mg BID, adalimumab 40 mg Q2W, etanercept 25 mg BIW, golimumab 50/100 mg QM or infliximab 5 mg/kg Q2M. Conclusions: This placebo-response adjusted NMA showed that SEC has at least comparable efficacy against all licensed biologics in PsARC and superiority over APR at some doses.
Thom, H., Jugl, S., McInnes, I., Nash, P., Ritchlin, C., Kanters, S., … Mpofu, S. (2016). Psoriatic Arthritis Response Criteria Scores: Results From A Placebo-Response Adjusted Network Meta-Analysis With Secukinumab. Value in Health, 19(3), A226. https://doi.org/10.1016/j.jval.2016.03.1167