Background/Purpose:

Multiple disease-modifying therapies
for treatment of psoriatic arthritis (PsA) are available. However, there are limited
data directly comparing these biologic therapies and the recently approved phosphodiesterase-4
(PDE-4) inhibitor. In the absence of head-to-head trials, it is difficult for
decision makers to make treatment choices in real world scenarios. The aim of
this study was to conduct a network meta-analysis (NMA) to indirectly compare
the efficacy of biologic agents and apremilast for treatment of active PsA.

Methods:

A
systematic literature review was conducted to identify Phase III randomized controlled
trials (RCTs) for tumor necrosis factor inhibitors (TNFi’s:
adalimumab, infliximab, golimumab, etanercept, and certolizumab), interleukin
inhibitors (ustekinumab and secukinumab), and a PDE-4 inhibitor (apremilast)
for active PsA. The relative probabilities of
achieving ACR20 and PASI75 responses at week 24 with each agent were estimated
via a Bayesian network meta-analysis. All arms of the network meta-analysis
included FDA-approved doses for PsA except
secukinumab, where all three doses examined in RCTs: 75, 150, and 300 mg every
4 weeks were included. Numbers needed to treat (NNT) were calculated as the
reciprocal of the incremental response rate of each treatment versus placebo. Analyses
were repeated among subgroups of patients without prior biologic therapy.

Results:

Seventeen
RCTs were identified, 14 included ACR20 and/or PASI75 responses at Week 24. Among
all patients and biologic-naive patients, adalimumab, golimumab, infliximab,
and secukinumab (300 and 150 mg) had NNTs <3 for ACR20 responses at Week 24,
and adalimumab the lowest NNT of 2.32 (95% credible interval [CrI] 1.78, 3.22;
Figure 1). Among all patients and biologic-naive patients, infliximab,
golimumab, and adalimumab had NNTs <2 for PASI75 responses at Week 24, and
infliximab the lowest NNT of 1.53 (1.25, 2.01; Figure 2).  PASI75 responses among biologic-naïve
patients were not available for secukinumab, certolizumab, and apremilast.

Conclusion:

At Week 24,
adalimumab, golimumab, secukinumab 300 mg, and infliximab had the lowest NNTs
per ACR20 and/or PASI75 responders among all patients as well as among biologic-naïve
patients.

Figure 1. Numbers needed to treat to
achieve one additional ACR 20 responder

s

Figure 2. Numbers needed to treat to
achieve one additional PASI 75 responder

s