Efficacy of secukinumab and adalimumab in psoriatic arthritis patients with moderate-to-severe plaque psoriasis: Results from the EXCEED study

Abstract

Introduction: The EXCEED study investigated whether secukinumab is superior to adalimumab in biologic-naïve, active psoriatic arthritis (PsA) patients with active plaque psoriasis (PsO). Objectives: To report 1) skin, 2) musculoskeletal, and 3) composite indices outcomes from a prespecified analysis in the subset of patients with moderate-to-severe plaque PsO (PsO subset) having body surface area (BSA)>10% or PASI ≥10 at baseline. Methods: The study design has been described elsewhere. The primary endpoint was superiority of secukinumab vs adalimumab on ACR20 response at Week 52. The prespecified outcomes analyzed in PsO subset were PASI75/90/100 and Dermatology Life Quality Index 0/1 response. Other clinically relevant musculoskeletal (ACR20/50/70 response and resolution of enthesitis/dactylitis) and composite indices outcomes were also assessed. Binary and continuous variables were analyzed using logistic regression model and MMRM, respectively. Multiple imputation was used for handling missing data. Results: In total, 853 patients were randomized, 211 (24.7%) of whom had PsO with BSA>10% or PASI ≥10 at baseline (secukinumab [n = 110] and adalimumab [n = 101]). 5.5% patients discontinued treatment in secukinumab vs 17.8% patients in adalimumab before Week 52. A higher proportion of patients achieved simultaneous ACR50 and PASI100 response with secukinumab (28.2%) vs adalimumab (17.7%), P = .0604 at Week 52. Numerically higher responses were observed for secukinumab vs adalimumab at Week 52 in skin, musculoskeletal and composite indices outcomes. Conclusions: Secukinumab provided numerically higher responses compared with adalimumab in skin, musculoskeletal, composite indices and in achievement of simultaneous improvement of musculoskeletal and skin disease at Week 52 with a higher retention rate.