The interleukin-17A inhibitor secukinumab offers benefit versus adalimumab for patients with active psoriatic arthritis (PsA) with concomitant moderate-to-severe plaque psoriasis, according to a study published in the December issue of the British Journal of Dermatology.

Alice B. Gottlieb, M.D., Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported 52-week results from a prespecified analysis of patients with active PsA with concomitant moderate-to-severe plaque psoriasis from the EXCEED monotherapy head-to-head study. Patients were randomly assigned to receive secukinumab (426 patients) or adalimumab (427 patients) via subcutaneous injection; 24.7 percent of these patients (110 [25.8 percent] and 101 [23.7 percent], respectively) had concomitant moderate-to-severe psoriasis.

Up to week 50, 5.5 and 17.8 percent of patients discontinued secukinumab and adalimumab, respectively. The researchers found that at week 52, the proportion of patients who achieved the American College of Rheumatology (ACR) 20 response was 76.4 and 68.3 percent with secukinumab and adalimumab, respectively; Psoriasis Area and Severity Index 100 percent (PASI 100) response occurred in 39.1 and 23.8 percent, respectively; and simultaneous improvement in ACR 50 and PASI 100 response occurred in 28.2 and 17.7 percent, respectively. Across skin end points, secukinumab demonstrated consistently higher responses versus adalimumab.

"Gottlieb et al. provide a first step to guiding the treatment strategy, depending on the patient's characteristics," write the authors of an accompanying editorial. "Repeated similar subgroup analyses in randomized controlled trials, and subgroup and individual participant data network meta-analyses, are needed to achieve precision medicine."

Several authors disclosed financial ties to pharmaceutical companies, including Novartis, which manufactures secukinumab and funded the study.

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