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Older TNF Drugs Work Better Than Newer Ones for Psoriatic Arthritis
A meta-analysis has found that older tumor necrosis factor (TNF) inhibitors or secukinumab work better than newer biologic products in patients with psoriatic arthritis (PsA) who have an inadequate response to or are unable to tolerate disease-modifying antirheumatic drugs (DMARDs) or nonsteroidal anti-inflammatory drugs (NSAIDs).
Twelve studies were included in the meta-analysis, which examined a total of 1,989 patients in experimental arms and 1,175 in placebo arms. Efficacy was evaluated based on attainment of a 20% improvement according to American College of Rheumatology criteria (ACR20).
MedPage Today reports that the pooled risk ratio (RR) of achieving an ACR20 response with an older TNF inhibitor was significantly greater than with apremilast 20 mg (RR, 3.36; 95% confidence interval [CI], 2.10–5.38), apremilast 30 mg (RR, 2.42; 95% CI, 1.55–3.77), ustekinumab 45 mg (RR, 2.38; 95% CI, 1.68–3.35), ustekinumab 90 mg (RR, 2.08; 95% CI, 1.48–2.93), and certolizumab (RR, 2.20; 95% CI, 1.48–3.26).
However, the likelihood of achieving an ACR20 response from older TNF inhibitors was not different from secukinumab 75 mg (RR, 1.90; 95% CI, 0.95–3.78), 150 mg (RR, 1.10; 95% CI, 0.58–2.09), or 300 mg (RR, 1.21; 95% CI, 0.63–2.29). The likelihood of achieving an ACR20 response was higher with secukinumab at the 150-mg and 300-mg weekly doses compared with apremilast, ustekinumab, and certolizumab, although not all comparisons reached statistical significance. There were no significant differences between apremilast, ustekinumab, and certolizumab on ACR20 response.
All older TNF inhibitors yielded a significantly higher likelihood of achieving an ACR 20 response compared with apremilast, ustekinumab, and certolizumab with the exception of adalimumab, which was not significantly better when compared with certolizumab, ustekinumab 45 mg, and ustekinumab 90 mg.
Limitations of the study include indirect comparisons that assume common comparators, the funding source (pharmaceutical companies) for all of the studies included in the meta-analysis, the small number of trials included, and specific clinical situations for which the comparisons were conducted (patients who had already tried DMARDs or NSAIDs).
Source: MedPage Today, October 16, 2015.