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.

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.To report 52-week results from a pre-specified analysis of patients with active psoriatic arthritis (PsA) having concomitant moderate to severe plaque psoriasis from head-to-head EXCEED monotherapy study comparing secukinumab with adalimumab.Patients were randomised to receive secukinumab 300 mg subcutaneous at baseline, Week 1-4, followed every four weeks (q4w) until Week 48 or adalimumab 40 mg subcutaneous q2w from baseline until Week 50. Assessments in patients with concomitant moderate to severe psoriasis, defined as having body surface area (BSA)>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.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% patients discontinued secukinumab vs.17.8% in the adalimumab group. Proportion of patients who achieved American College of Rheumatology (ACR) 20 response was 76.4% with secukinumab vs. 68.3% with adalimumab (p=0·1752), PASI 100 response was 39.1% vs. 23.8%, (p=0.0136) and simultaneous improvement in ACR50 and PASI 100 response at Week 52 was 28.2% vs.17.7%, respectively(p=0.0604). Secukinumab demonstrated consistently higher responses vs. adalimumab across skin endpoints.This pre-specified analysis in PsA patients with concomitant moderate to severe plaque psoriasis in the EXCEED study provides further evidence that interleukin-17 inhibitors offer a comprehensive biologic treatment to manage the concomitant features of psoriasis and PsA.

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Authors: A B Gottlieb, J F Merola, K Reich, F Behrens, P Nash, C E M Griffiths, W Bao, P Pellet, L Pricop, I B McInnes