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Relative efficacy and safety of apremilast, secukinumab, and ustekinumab for the treatment of psoriatic arthritis

Relative Wirksamkeit und Sicherheit von Apremilast, Secukinumab und Ustekinumab bei der Behandlung einer aktiven Psoriasisarthritis

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Abstract

Objective

To assess the relative efficacy and safety of apremilast, secukinumab, and ustekinumab at different doses in patients with active psoriatic arthritis (PsA).

Method

A Bayesian network meta-analysis was conducted, which included randomized controlled trials (RCTs) that examined the efficacy and safety of apremilast 20 mg, apremilast 30 mg, secukinumab 75 mg, secukinumab 150 mg, secukinumab 300 mg, ustekinumab 45 mg, and ustekinumab 90 mg compared with placebo.

Results

Of the RCTs 8 comprising 3289 patients met the inclusion criteria. The American College of Rheumatology (ACR) 20 response rate was significantly higher in the secukinumab 300 mg group than in the placebo group (odds ratio OR, 7.55; 95% confidence interval CI, 3.18–17.63). Secukinumab 150 mg, secukinumab 75 mg, ustekinumab 90 mg, apremilast 30 mg, apremilast 20 mg, and ustekinumab 45 mg were also more efficacious than placebo. There were no significant differences in the efficacy between the interventions. A dose-response relationship among the same drug groups was observed. The number of serious adverse events was not significantly different among the apremilast, secukinumab, ustekinumab, and placebo groups.

Conclusion

All drug treatments were more efficacious than placebo; however, there were no significant differences in the efficacy and safety between the drugs at the different doses.

Zusammenfassung

Ziel

Ziel dieser Studie war es, die relative Wirksamkeit und Sicherheit von Apremilast, Secukinumab und Ustekinumab in unterschiedlichen Dosierungen bei Patienten mit aktiver Psoriasisarthritis (PsA) zu untersuchen.

Methode

Eine Bayessche-Netzwerk-Metaanalyse wurde durchgeführt, die randomisierte kontrollierte Studien (RCT) einschloss, welche die Wirksamkeit und Sicherheit von Apremilast 20 mg, Apremilast 30 mg, Secukinumab 75 mg, Secukinumab 150 mg, Secukinumab 300 mg, Ustekinumab 45 mg und Ustekinumab 90 mg verglichen mit Placebo untersuchten.

Ergebnisse

Von den RCT erfüllten 8 Studien mit 3289 Patienten die Einschlusskriterien. Die Ansprechrate nach den Kriterien des American College of Rheumatology (ACR) 20 war signifikant höher in der Secukinumab-300-mg-Gruppe als in der Placebogruppe (Odds-Ratio: 7,55; 95% Konfidenzintervall [CI] 3,18–17,63). Secukinumab 150 mg, Secukinumab 75 mg, Ustekinumab 90 mg, Apremilast 30 mg, Apremilast 20 mg und Ustekinumab 45 mg waren ebenfalls wirksamer als Placebo. Bei den Interventionen gab es keine signifikanten Unterschiede bezüglich der Wirksamkeit. Unter den gleichen Arzneimittelgruppen wurde eine Dosis-Wirkungs-Beziehung beobachtet. Die Anzahl schwerer unerwünschter Ereignisse unterschied sich in den Gruppen mit Apremilast, Secukinumab, Ustekinumab und Placebo nicht signifikant.

Schlussfolgerung

Alle medikamentösen Behandlungen waren wirksamer als Placebo; jedoch gab es keine signifikanten Unterschiede bezüglich der Wirksamkeit und Sicherheit bei den Arzneimitteln in unterschiedlichen Dosierungen.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, 136-705, Seoul, Korea (Republic of)

    G. G. Song & Y. H. Lee MD, PhD

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  1. G. G. Song
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Correspondence to Y. H. Lee MD, PhD.

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Conflict of interest

G.G. Song and Y.H. Lee declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

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Song, G.G., Lee, Y.H. Relative efficacy and safety of apremilast, secukinumab, and ustekinumab for the treatment of psoriatic arthritis. Z Rheumatol 77, 613–620 (2018). https://doi.org/10.1007/s00393-017-0355-8

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