medwireNews: Biologic DMARDs have favorable efficacy and safety profiles in patients with active psoriatic arthritis (PsA), with few statistically significant differences seen among the individual agents, report the authors of a systematic review and network meta-analysis (NMA).
Given that evidence from randomized head-to-head trials of different biologics in PsA is scarce, “NMA can be used to complement the direct evidence to allow for an assessment of comparative efficacy,” and “expand the scope of traditional pairwise indirect comparisons by combining direct and indirect evidence,” say Richard Perry (Adelphi Values, Bollington, UK) and colleagues.
The NMA included a total of 25 randomized trials of biologic DMARDs in patients with PsA, the majority of which were placebo-controlled, double-blind studies with no active comparator. In all, 22 studies involved a biologic-naïve study population and were used for the efficacy analysis.
Perry and team report that the biologics had good efficacy overall, with “generally few statistically significant differences between most treatments.”
ACR20, 50, and 70 response rates were significantly higher among patients treated with biologics versus placebo, with the exception of two abatacept-containing regimens. The greatest differences relative to placebo were seen for the tumor necrosis factor (TNF) inhibitors infliximab, golimumab, and etanercept, and the researchers note that these agents were statistically superior to most other treatments, but golimumab and etanercept were not superior to ixekizumab given at a dose of 80 mg every 2 weeks.
Similar overall benefits were seen for skin responses, with all treatments except abatacept and etanercept associated with significantly higher PASI50, 75, 90, and 100 response rates relative to placebo. The greatest benefits were seen with infliximab, followed by ixekizumab.
Ixekizumab at a dose of either 80 mg every 2 weeks or 80 mg every 4 weeks was statistically superior to a number of other agents, including adalimumab, for skin responses. The researchers say that these findings “are consistent with the recently completed [SPIRIT-H2H] study,” which was published after the systematic literature review for the present study was conducted.
In the safety analysis, none of the biologics were associated with a significantly higher or lower risk for experiencing a treatment-emergent adverse event (TEAE) relative to placebo or any of the other biologics. The risk for serious AEs was also comparable across treatments, with the exception of a higher risk among patients treated with ixekizumab 80 mg every 2 weeks versus golimumab.
Together, these findings confirm “the efficacy and acceptable safety profile of [biologic] DMARDs in patients with active PsA,” conclude Perry and team in RMD Open.
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