Main trial data from the head-to-head EXCEED trial showed that, for patients who suffer from psoriatic arthritis and who are biologic-naïve, secukinumab monotherapy does not offer greater musculoskeletal benefits than adalimumab [1].
The EXCEED trial is a phase 3b study of patients with active psoriatic arthritis and an inadequate response or intolerance to conventional disease-modifying anti-rheumatic drugs (DMARDs). The trial compared secukinumab and adalimumab as first-line biologic monotherapy through 52 weeks, with a musculoskeletal primary endpoint.
A total of 853 patients were randomised to secukinumab 300 mg/week at weeks 0-4 and every 4 weeks thereafter (n=426) or adalimumab 40 mg subcutaneous at baseline and then every 2 weeks until week 50 (n=427). Baseline demographics and disease characteristics were comparable between treatment-groups apart from the fact that the secukinumab group held a higher proportion of female patients as well as patients without enthesitis.
Results showed that ACR20 response at week 52 was achieved by 67.4% of secukinumab-treated patients versus 61.5% of adalimumab-treated patients (P=0.0719). As the primary endpoint was not met, key secondary endpoints were not formally evaluated for statistical significance. However, it was clear that a PASI90 skin response was achieved by more secukinumab-treated patients than those treated with adalimumab (65% vs 43%, respectively). Also, a simultaneous ACR50 and PASI100 response was achieved by 31% of secukinumab-treated patients versus 19% of adalimumab-treated patients. Another difference between the groups concerned treatment discontinuation rates (14% with secukinumab vs 24% with adalimumab). The most important reasons for discontinuation were patient or guardian decision, adverse events, and lack of efficacy.
Reference:
1. McInnes IB, et al. Secukinumab versus adalimumab for treatment of active psoriatic arthritis (EXCEED): a double-blind, parallel-group, randomised, active-controlled, phase 3b trial. OP0227. EULAR 2020.