A new study comparing secukinumab and adalimumab in treating psoriatic arthritis (PsA) reveals distinct advantages for each drug. While both are effective, secukinumab is more suitable for severe skin involvement, and adalimumab is better for significant ultrasound-confirmed synovitis.
Comparative Efficacy in Psoriatic Arthritis
Yiyi Wang and colleagues from the West China Hospital's Department of Dermatology noted, "Our analysis pinpointed distinct advantages for each medication in managing PsA." The study addresses the ongoing question of which drug is more effective for treating PsA, given that both secukinumab and adalimumab are approved for this purpose by the National Medical Products Administration.
PsA often starts with joint stiffness and tender, swollen joints, potentially leading to irreversible joint damage that diminishes quality of life and increases socioeconomic burdens. Current guidelines recommend biological disease-modifying anti-rheumatic drugs (bDMARDs), specifically tumor necrosis factor inhibitors and interleukin-17 inhibitors, for treating PsA across all core domains.
Study Design and Outcomes
The prospective cohort study involved 116 participants from the PARWCH database at West China Hospital between 2020 and October 2022. Participants were adults (≥ 18 years) with confirmed PsA who received either secukinumab (n = 58) or adalimumab (n = 58). Those with other forms of arthritis were excluded. Follow-ups occurred at weeks 4, 12, 24, and 52. 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.
At week 12, there was no significant difference in ACR20 response between the secukinumab and adalimumab groups (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.26 – 1.37; P = .22). However, secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR, 2.25; 95% CI, 1.07 – 3.74; P = .03), indicating it is more effective for severe skin involvement.
Conversely, adalimumab showed 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), suggesting it is a better option for enhancing inflammatory joint changes.
Implications for Clinical Practice
Despite these differences, the study found that neither adalimumab nor secukinumab could reverse structural abnormalities like enthesophytes and bone erosions. The investigators emphasized the importance of ultrasound in guiding treatment choices and monitoring disease activity in PsA.
The study's limitations include its non-randomized design, which could introduce selection bias and potential confounders. The researchers called for larger-scale, long-term comparative real-world studies to assess the implications of ultrasound results.
In conclusion, the investigators suggested, "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. 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."
