Introduction & Objectives: A mixed-treatment comparison (MTC) assessed the relative efficacy of secukinumab versus other biologics in patients with moderate-to-severe psoriasis.
Methods: A systematic literature review (SLR) was performed using MEDLINE, EMBASE and Cochrane Library, from inception to June 2013, including randomized control trials of secukinumab, etanercept, adalimumab, infliximab and ustekinumab. Binomial MTCs were used to model Psoriasis Area Severity Index (PASI) 75 and PASI 90. Bayesian random effects models are presented, fixed effects gave similar results. All analyses were conducted in R (R Development Core Team, 2013). For placebo patients with no data at 16 weeks, 12-week data was carried forward. Results of PASI 75 and PASI 90 analyses at 12 and 16 weeks are presented.
Results: A total of 28 trials (etanercept:7; ustekinumab:7; adalimumab:6; infliximab:6) from the SLR and 5 phase 3 secukinumab trials were included in the MTCs. Secukinumab 300mg was the highest in the treatment hierarchy among all biologics [cumulative area under rankogram] for PASI 75 [0.98] and PASI 90 [0.94] responses. At 12 weeks, secukinumab 300mg was statistically superior to etanercept 50mg and ustekinumab 45mg and 90mg and similar to adalimumab 80/40mg and infliximab for PASI 75 responses. For PASI 90 responses secukinumab 300mg was superior to etanercept 50mg, ustekinumab 45mg and adalimumab 80/40mg and similar to ustekinumab 90mg and infliximab. At 16 weeks, secukinumab 300mg was statistically superior to etanercept 25mg, 50mg and ustekinumab 45mg and 90mg for PASI75 responses. For PASI 90 responses secukinumab 300mg was superior to adalimumab 80/40mg, etanercept, and ustekinumab 45mg. Odds ratio (95% CI) of response for Secukinumab 300mg versus comparators. Odds ratios >1 favour Secukinumab. Secukinumab 150mg achieved lower responses than secukinumab 300mg; however had statistically superior efficacy to some biologics at 12 and 16 weeks.
Conclusions: Secukinumab 300mg was the highest in the treatment hierarchy at 16 weeks among all psoriasis biologics in the network for PASI 75 and PASI 90. As measured by PASI response, relative secukinumab efficacy to most other biologics in treating moderate to severe psoriasis patients is statistically superior at 12 and 16 weeks.