ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1561

Network Meta-Analysis of Targeted Immunomodulators in the Treatment of Biologic-NaïVe Psoriatic Arthritis

Vibeke Strand1, M. Elaine Husni2, Rakesh Singh3, Keith Betts4, Yan Song5, Jenny Griffith3 and Arijit Ganguli3, 1Stanford University, Palo Alto, CA, 2Cleveland Clinic, Cleveland, OH, 3AbbVie Inc., North Chicago, IL, 4Analysis Group, Inc., Los Angeles, CA, 5Analysis Group, Inc., Boston, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , ,

Session Information

Date: Monday, November 6, 2017

Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Psoriatic arthritis (PsA) is an inflammatory condition characterized by peripheral arthritis and psoriatic skin lesions requiring therapies that control both skin and joint symptoms. In the absence of head-to-head trials, indirect comparison provides informative evidence for decision makers. This study compared the clinical (ACR 20/50/70; PASI 75/90) and cost-effectiveness outcomes of targeted immunomodulators (TIMs) among PsA patients without prior biologic treatment via a network meta-analysis (NMA).

Methods: A systematic literature review was conducted to identify Phase 3 randomized controlled trials (RCTs) for tumor necrosis factor-α inhibitors (TNFi’s: adalimumab [ADA], certolizumab pegol [CZP], etanercept [ETN], golimumab [GOL], and infliximab [INF]), an interleukin-17A inhibitor (secukinumab [SEC]), an interleukin-12/23 inhibitor (ustekinumab [UST]), and a phosphodiesterase-4 inhibitor (apremilast [APR]) in active PsA. Joint (ACR 20/50/70) and skin (PASI 75/90) responses at Week 24 were estimated via Bayesian NMA among biologic-naïve patients. Treatment costs were based on Wholesale Acquisition Cost as of May 8, 2017 and included drug acquisition and administration costs. Incremental costs per responder relative to placebo were calculated as incremental treatment costs during 24 weeks divided by response rate difference vs. placebo.

Results: Eleven RCTs that reported ACR and/or PASI responses at Week 24 among biologic-naïve PsA patients were included. GOL, ADA, and SEC 150 had higher ACR 20 response than other TIMs. In terms of ACR 50, INF, ETN, and ADA had higher efficacy compared with other TIMs (Table 1). With respect to ACR 70 and PASI responses, ADA, INF, and GOL had higher efficacy than other TIMs. In terms of cost-effectiveness, INF ($50,812 for ACR 50/$35,227 for PASI 75), ADA ($78,608/$41,093), and GOL ($80,533/$37,443) were associated with lower incremental costs per additional ACR 50 responder and per additional PASI 75 responder than other TIMs (Figure 1A). A similar ranking of these drugs was observed in ICPR for ACR 70 and PASI 90 (Figure 1B).

Conclusion: At Week 24, INF, GOL, and ADA had the lowest incremental cost per responder for joint and skin outcomes in PsA patients without prior biologic treatments.

 

Table 1. ACR 20/50/70 and PASI 75/90 response rates at Week 241

ACR response rates

 

PASI response rates

ACR 20

ACR 50

ACR 70

 

PASI 75

PASI 90

PBO

17.5% (15.5%, 19.6%)

6.3% (5.0%, 7.8%)

2.4% (1.7%, 3.5%)

 

6.6% (4.3%, 9.8%)

2.2% (1.2%, 3.7%)

ADA

62.0% (48.6%, 74.4%)

40.2% (24.7%, 60.2%)

40.2% (15.2%, 82.1%)

 

71.7% (53.0%, 86.2%)

52.2% (33.2%, 71.7%)

APR

32.9% (24.4%, 42.8%)

12.7% (6.3%, 25.2%)

2.8% (0.9%, 8.2%)

 

—

—

CZP

47.6% (35.2%, 60.8%)

22.2% (13.3%, 35.9%)

16.1% (6.9%, 37.8%)

 

—

—

ETN

50.9% (35.8%, 66.5%)

44.0% (24.4%, 69.2%)

8.9% (2.5%, 32.6%)

 

23.9% (11.8%, 41.8%)

11.1% (4.3%, 23.7%)

GOL

62.4% (46.6%, 77.0%)

37.3% (20.0%, 62.6%)

26.9% (8.8%, 71.6%)

 

73.3% (55.6%, 87.1%)

54.3% (35.2%, 73.2%)

INF

57.1% (40.6%, 72.9%)

54.5% (30.2%, 81.2%)

33.7% (11.5%, 77.8%)

 

76.3% (59.5%, 88.9%)

57.9% (39.3%, 75.9%)

SEC 150

58.5% (46.8%, 69.7%)

36.4% (23.8%, 52.5%)

24.4% (11.2%, 50.4%)

 

32.4% (13.7%, 59.2%)

16.6% (5.4%, 39.2%)

SEC 300

56.2% (39.1%, 72.3%)

32.8% (17.7%, 53.4%)

21.1% (7.8%, 49.5%)

 

43.8% (20.4%, 71.3%)

25.2% (9.1%, 51.5%)

UST 45

35.3% (26.6%, 45.2%)

19.0% (11.3%, 31.0%)

12.5% (5.0%, 31.6%)

 

47.1% (33.2%, 62.1%)

28.0% (17.0%, 42.1%)

UST 90

41.1% (31.8%, 51.3%)

21.6% (13.1%, 34.4%)

14.6% (6.1%, 35.4%)

 

52.3% (38.0%, 66.7%)

32.4% (20.3%, 47.2%)

[1] PASI 75 and PASI 90 responses for APR and CZP were not reported among biologic naïve population.

Figure 1. Incremental cost per responder over 24 weeks (ACR 50 vs. PASI 75 and ACR 70 vs. PASI 90)1

[1] ICPR for ACR 50 and ACR 70 in CZP were $173,601 and $201,998. ICPR for ACR 50 and ACR 70 in APR were $250,338 and $4,659,629.
PASI responses were not reported for CZP and APR in the biologic-naïve population.

 

Disclosure: V. Strand, AbbVie, Alder, Amgen, BMS, Celgene, Genentech, Janssen, Novartis, Pfizer, and UCB, 5,AbbVie, Amgen, BMS, Celgene, Genentech, Janssen, Novartis, Pfizer, and UCB, 9; M. E. Husni, Celgene, AbbVie, Genentech, Bristol-Myers Squibb, Pfizer, Novartis, and Janssen, 9; R. Singh, AbbVie, 3,AbbVie, 1; K. Betts, Analysis Group, which has received consulting fees from AbbVie to partner on this research, 3; Y. Song, Analysis Group, which has received consulting fees from AbbVie to partner on this research, 3; J. Griffith, AbbVie, 1,AbbVie, 3; A. Ganguli, AbbVie, 3,AbbVie, 1.

To cite this abstract in AMA style:

Strand V, Husni ME, Singh R, Betts K, Song Y, Griffith J, Ganguli A. Network Meta-Analysis of Targeted Immunomodulators in the Treatment of Biologic-NaïVe Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/network-meta-analysis-of-targeted-immunomodulators-in-the-treatment-of-biologic-naive-psoriatic-arthritis/. Accessed .

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