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Ruyssen-Witrand A, Perry R, Watkins C, Braileanu G, Kumar G, Kiri S, Nott D, Liu-Leage S, Hartz S, Sapin C. Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis. RMD Open 2020; 6:e001117. [PMID: 32094304 PMCID: PMC7046955 DOI: 10.1136/rmdopen-2019-001117] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/03/2020] [Accepted: 01/31/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs are used in patients with psoriatic arthritis (PsA), but few studies directly compare their clinical efficacy. In such situations, network meta-analysis (NMA) can inform evidence-based decision-making. OBJECTIVE To evaluate the comparative efficacy and safety of approved bDMARDs in patients with PsA. METHODS Bayesian NMA was conducted to compare the clinical efficacy of bDMARDs at weeks 12‒16 in bDMARD-naïve patients with PsA in terms of American College of Rheumatology (ACR) criteria, Psoriatic Arthritis Response Criteria (PsARC) and Psoriasis Area and Severity Index (PASI). Safety end points were evaluated in the overall mixed population of bDMARD-naive and bDMARD-experienced patients. RESULTS For ACR, all treatments except abatacept were statistically superior to placebo. Infliximab was most effective, followed by golimumab and etanercept, which were statistically superior to most other treatments. Ixekizumab 80 mg every 2 weeks (Q2W) was statistically superior to abatacept subcutaneous, apremilast and both regimens of ustekinumab; similar findings were observed for ixekizumab 80 mg Q4W. For PsARC response, ixekizumab did not significantly differ from other therapies, except for golimumab, infliximab and etanercept, which were superior to most other agents including ixekizumab. For PASI response, infliximab was numerically most effective, but was not statistically superior to ixekizumab, which was the next best performing agent. Analysis of safety end points identified few differences between treatments. CONCLUSION Our NMA confirms the efficacy and acceptable safety profile of bDMARDs in patients with active PsA. There were generally few statistically significant differences between most treatments.
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Affiliation(s)
- Adeline Ruyssen-Witrand
- Rheumatology Center, Purpan Teaching Hospital, Toulouse, France
- Rheumatology Center, UMR 1027, Inserm, Paul Sabatier University Toulouse III, Toulouse, France
| | - Richard Perry
- Value Demonstration and Communication, Adelphi Values, Bollington, Cheshire, UK
| | - Clare Watkins
- Statistical Consultancy, Clarostat Consulting Ltd, Alderley Edge, Cheshire, UK
| | - George Braileanu
- Value Demonstration and Communication, Adelphi Values, Bollington, Cheshire, UK
| | - Gayathri Kumar
- Health Economics & Pricing, Reimbursement and Access, Eli Lilly and Company Ltd, Basingstoke, UK
| | - Sandeep Kiri
- Health Outcomes and Health Technology Assessment, Eli Lilly and Company Ltd, Basingstoke, UK
| | - Debby Nott
- Health Outcomes and Health Technology Assessment, Eli Lilly and Company Ltd, Basingstoke, UK
| | - Soyi Liu-Leage
- International Business Unit-Rheumatology, Lilly France, Neuilly-sur-Seine, France
| | - Susanne Hartz
- Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Windlesham, UK
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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Mease PJ, Van den Bosch F, Sieper J, Xia Y, Pangan AL, Song IH. Performance of 3 Enthesitis Indices in Patients with Peripheral Spondyloarthritis During Treatment with Adalimumab. J Rheumatol 2017; 44:599-608. [PMID: 28298558 DOI: 10.3899/jrheum.160387] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the validity of enthesitis indices in patients with peripheral spondyloarthritis (pSpA). METHODS The ABILITY-2 study evaluated the efficacy of adalimumab (ADA) versus placebo (PBO) in patients with active pSpA over 12 weeks. Patients received open-label ADA for an additional 144 weeks. Twenty-nine enthesitis sites used in 3 enthesitis scoring systems [Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES)] were assessed; discriminatory capacity and treatment response at Week 12 were calculated by standardized mean difference (SMD) and Guyatt's effect size (ES). Sites showing resolution or new-onset enthesitis from baseline to Week 12 were analyzed. RESULTS Overall, 165 patients (ADA, n = 84; PBO, n = 81) were randomized; 143 had ≥ 1 enthesitis site at baseline. The LEI (SMD -0.73, ES -1.07) and SPARCC (SMD -0.56, ES -0.99) enthesitis indices showed higher discriminatory ability and treatment response than MASES (SMD -0.32, ES -0.81). At Week 12, among sites that were positive at baseline, significantly more (p < 0.05) showed resolution among patients treated with ADA versus PBO in the Achilles tendon (60.4% and 36.5%, respectively), medial epicondyle (73.2%, 48.7%), lateral epicondyle (80.6%, 52.8%), and iliac crest (73.5%, 47.2%). Among negative sites at baseline, significantly less (p < 0.05) new-onset enthesitis was observed with ADA versus PBO for Achilles tendon (3.6% and 10.9%, respectively), greater trochanter (3.4%, 14.4%), lateral epicondyle humerus (4.7%, 15.1%), medial femoral condyle (1.6%, 9.2%), and quadriceps insertion superior patella (1.5%, 7.0%). CONCLUSION The LEI and SPARCC enthesitis indices showed better discriminatory capacity and treatment response in patients with pSpA versus MASES, likely because these indices contain more peripheral sites. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01064856.
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Affiliation(s)
- Philip J Mease
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany. .,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB. .,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc.
| | - Filip Van den Bosch
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB.,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc
| | - Joachim Sieper
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB.,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc
| | - Yinglin Xia
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB.,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc
| | - Aileen L Pangan
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB.,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc
| | - In-Ho Song
- From Rheumatology Research, Swedish Medical Center, and University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Illinois at Chicago; Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.,P.J. Mease has received research grants and consulting fees from Amgen, Lilly, Novartis, and Pfizer. F. Van den Bosch has received consultancy and/or speaker fees from Janssen, Novartis, and UCB.,P.J. Mease, MD, Director, Rheumatology Research, Swedish Medical Center, and Clinical Professor, University of Washington School of Medicine; F. Van den Bosch, MD, PhD, Department of Rheumatology, Ghent University Hospital; J. Sieper, MD, PhD, Department of Medicine I, Rheumatology, Charité Universitätsmedizin Berlin; Y. Xia, PhD, Department of Medicine, University of Illinois at Chicago; A.L. Pangan, MD, Immunology Clinical Development, AbbVie Inc.; I.H. Song, MD, Immunology Clinical Development, AbbVie Inc
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