Efficacy of secukinumab and adalimumab in psoriatic arthritis patients with concomitant moderate to severe plaque psoriasis: results from the EXCEED, a randomised, double‐blind head‐to‐head monotherapy study

Gottlieb, A.B., Merola, J.F., Reich, K., Behrens, F., Nash, P., Griffiths, C.E.M., Bao, W., Pellet, P., Pricop, L. and McInnes, I.B. (2021) Efficacy of secukinumab and adalimumab in psoriatic arthritis patients with concomitant moderate to severe plaque psoriasis: results from the EXCEED, a randomised, double‐blind head‐to‐head monotherapy study. British Journal of Dermatology, 185(6), pp. 1124-1134. (doi: 10.1111/bjd.20413) (PMID:33913511) (PMCID:PMC9291158)

Abstract

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McInnes, Professor Iain

Creator Roles

McInnes, I.B.: Investigation, Writing – review and editing

• Authors: Gottlieb, A.B., Merola, J.F., Reich, K., Behrens, F., Nash, P., Griffiths, C.E.M., Bao, W., Pellet, P., Pricop, L., and McInnes, I.B.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: British Journal of Dermatology
• Publisher: Wiley
• ISSN: 0007-0963
• ISSN (Online): 1365-2133
• Published Online: 29 April 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in British Journal of Dermatology 185(6): 1124-1134
• Publisher Policy: Reproduced under a Creative Commons License