Secukinumab not superior to adalimumab in patients with SpA who failed prior biologics
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Although secukinumab performs similarly to adalimumab in patients with spondyloarthritis who failed their first biological treatment, adalimumab proved superior in those who failed multiple biologics, according to data.
“Currently, the optimal treatment strategy for SpA in routine care remains to be established, and randomized head-to-head comparisons of secukinumab versus individual TNF [inhibitors] are awaited,” Bente Glintborg, MD, of the University of Copenhagen, and colleagues wrote in Arthritis Care & Research. “Recent recommendations acknowledge these evidence gaps — but state that treatment with TNFi should be preferred before secukinumab as first line biologic due do familiarity with long-term safety. However, in case of TNFi failure due to lack of effect, secukinumab should be favored.”
“Studies applying indirect comparisons based on data acquired from phase 3 trials of the respective drugs found similar or superior effectiveness of secukinumab versus adalimumab,” they added. “Many patients treated with biological in routine care would never be eligible for inclusion in a randomized trial due to atypical disease presentation, low disease activity, comorbidity, high age etc. Thus, observational studies contribute a valuable supplement to results from randomized trials.”
To analyze the effectiveness of secukinumab (Cosentyx, Novartis) compared with TNF inhibitors, specifically adalimumab (Humira, AbbVie), among patients with SpA, Glintborg and colleagues conducted an observational, prospective cohort study. The researchers analyzed data from five Nordic clinical rheumatology registries to identify patients with SpA who initiated secukinumab or a TNF inhibitor from 2015 to 2018. In addition, they retrieved data on comorbidities and extra‐articular manifestations — such as psoriasis, uveitis and inflammatory bowel disease — from national registries.
The researchers assessed 1‐year treatment retention — defined using crude survival curves and adjusted hazard ratios for treatment discontinuation — as well as 6 months of response rates. Measures include were ASDAS < 2.1/BASDAI < 40mm, crude/LUNDEX‐adjusted, and adjusted logistic‐regression analyses with odds‐ratio, all stratified by line of biological treatment — first, second and onward. In all, Glintborg and colleagues included 10,853 treatment courses in their analysis, including 842 with secukinumab and 10,011 with a TNF inhibitor, of which 1,977 were with adalimumab.
Among those who received the drug, secukinumab was the first biological treatment in 1% of patients, and the second biological drug in 6%, according to the researchers. A plurality — 22% — received secukinumab as a third-plus biological therapy.
According to Glintborg and colleagues, secukinumab demonstrated a 1‐year retention rate that was comparable to adalimumab as a first or second option, but poorer as a third-plus line of therapy, with 56% for secukinumab (51%‐61%) compared with 70% for adalimumab (64%‐75%), and an adjusted hazard ratio of 1.43 (95% CI, 1.12‐1.81).
In addition, secukinumab demonstrated poorer estimates for 6‐months response rates than adalimumab across treatment lines, but statistically significantly so only as a third-plus line of therapy (ASDAS < 2.1 OR = 0.56; 95% CI, 0.35‐0.9; BASDAI < 40mm OR = 0.62; 95% CI, 0.41‐0.95). Treatment outcomes varied across the five TNF inhibitors.
“Secukinumab was mainly prescribed in biological experienced SpA patients in this study based on >10,000 treatment courses from five Nordic countries,” Glintborg and colleagues wrote. “Outcomes in difficult-to treat patients that had failed more than two prior biologics were generally poor — and slightly poorer for secukinumab versus adalimumab, but similar to other TNFi. Our data did not support that secukinumab was superior to adalimumab or other TNFi after failing a previous TNFi.”
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