Secukinumab, Adalimumab Have Distinct Advantages for Treating PsA

A new study demonstrated secukinumab and adalimumab are both effective at treating psoriatic arthritis (PsA) but secukinumab was more suitable for severe skin involvement and adalimumab for significant ultrasound-confirmed synovitis.¹

“Notably, our analysis pinpointed distinct advantages for each medication in managing PsA,” wrote investigators, led by Yiyi Wang, from the department of dermatology at Rare Diseases Center in West China Hospital.

PsA symptoms may start as joint stiffness and tender and swollen joints but can transition to irreversible joint description: a condition linked to poor quality of life and socioeconomic burdens. Guidelines recommend biological disease-modifying anti-rheumatic drugs (bDMARDs) to treat PsA, but the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis specifically recommends tumor necrosis factor inhibitors and interleukin-17 inhibitors, 2 subclasses of bDMARDs, to treat PsA across all 6 core domains.²

Secukinumab and adalimumab, in the tumor necrosis factor inhibitor and interleukin-17 inhibitor classes, respectively, are approved by the National Medical Products Administration to treat PsA. The question remains: what drug is more effective at treating PsA?¹

Investigators conducted a prospective cohort study to compare the efficacy of secukinumab and adalimumab in patients with PsA through clinical and ultrasonographic evaluations. The primary outcome was the proportion of patients achieving ≥ 20% improvement in the ACR response (ACR20) at week 12. Secondary outcomes included evaluations for axial arthritis, enthesitis, skin involvement, minimal disease activity, health assessment questionnaires, and ultrasound changes.

Participants (n = 116), leveraged from the PARWCH database, attended the department of dermatology at West China Hospital between 2020 and October 2022 and were included if they were ≥ 18 years old, had a confirmed PsA diagnosis, and received secukinumab (n = 58) or adalimumab (n = 58). People were excluded if they were diagnosed with another form of arthritis. The team followed up participants at weeks 4, 12, 24, and 52.

Investigators reported that there was no significant difference in ACR20 response between participants on secukinumab or adalimumab at week 12 (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.26 – 1.37; P = .22).

Yet, secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR, 2.25; 95% CI, 1.07 – 3.74; P = .03). This indicated that secukinumab was better than adalimumab at treating severe skin involvement.

However, adalimumab demonstrated better improvement in ultrasound synovitis count (β: 0.94, 95% CI: 0.09 – 1.79, P = .03) and synovitis PD signal (β: 0.20, 95% CI: 0.03 –0.36, P = .02). The finding suggests adalimumab is a better option for enhancing inflammatory joint changes.

“Ultimately, we determined that neither adalimumab nor secukinumab could reverse structural abnormalities such as enthesophytes and bone erosions,” investigators wrote.

Despite this, investigators said the real-world data show the important role of ultrasound in guiding treatment choices and monitoring the disease activity of PsA.

They noted how the study was limited by its non-randomized design which could create selection bias and leave room for potential confounders. The team emphasized the need for a larger-scale, long-term comparative real-world study between secukinumab and adalimumab to assess the implications of ultrasound results.

“Secukinumab should be recommended as the preferred choice for patients with more severe skin involvement, whereas adalimumab could be better suited for patients experiencing more pronounced joint or back pain,” investigators concluded. “Additionally, based on detailed ultrasound examinations, both secukinumab and adalimumab are appropriate for PsA patients with axial involvement and/or peripheral arthritis, primarily exhibiting enthesitis, tenosynovitis, and bursitis. In case of ultrasound-confirmed significant synovitis, adalimumab might be the favored option.”

References

1. ^{Wang Y, Xiao Y, Zhang L, et al. Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments. J Dermatolog Treat. 2024;35(1):2411849. doi:10.1080/09546634.2024.2411849}
2. ^{Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024;83(6):706-719. Published 2024 May 15. doi:10.1136/ard-2024-225531}