Secukinumab Has a Greater Persistence Rate Than Ustekinumab in Psoriatic Arthritis

In the real world, the persistence rate with secukinumab to treat psoriatic arthritis (PsA) was higher than with ustekinumab, according to the results of a retrospective, national, multicenter, cohort study published in Rheumatology.

The European League Against Rheumatism (EULAR) recommends that patients with active peripheral who have an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (DMARDs) be initiated on biological DMARDs (bDMARDs). EULAR has noted that secukinumab and ustekinumab should be preferred in patients with PsA who have skin involvement.

However, there are no head-to-head trials comparing these 2 bDMARDs. Of the few real-world evidence studies, most had fewer than 100 patients enrolled.

The study, across 18 centers in France, included 406 patients who initiated secukinumab (n = 161) or ustekinumab (n = 245) between January 2011 and January 2019 and who had a diagnosis of PsA confirmed by a rheumatologist or who fulfilled the Classification Criteria for Psoriatic Arthritis. These patients were followed for at least 6 months. The primary end point was persistence (ie, time from initiation to discontinuation) at 2 years, and for patients who switched from one therapy to the other, only the first bDMARD was assessed for persistence.

After propensity score matching, the ustekinumab and secukinumab groups were not different on baseline characteristics. Less than one-fourth of both groups were bDMARD naive (22% for ustekinumab and 13% for secukinumab).

The median persistence was 9.4 months for ustekinumab and 14.7% for secukinumab, and in the proposenty-score matched analysis the persistence was lower in the ustekinumab group. In the analysis, the persistence rate was 40.9% at 1 year for ustekinumab compared with 59.1% for secukinumab. At 2 years, the rate was 25.5% for ustekinumab compared with 36.9% for secukinumab.

Nearly three-fourths (73.4%) of patients on ustekinumab discontinued the therapy. The most common reason was primary inefficacy (70.6%), followed by secondary inefficacy (21.1%), an adverse event (7.7%), and other causes (remission, 1.6%).

Less than half (45.9%) of patients on secukinumab discontinued. The most common reason was primary inefficacy (60.8%), followed by secondary inefficacy (21.6%), an adverse event (12.2%), and other causes (pregnancy and surgery, 5.4%).

The authors noted the size of the study as a strength, as well as the fact that most of the patients were not eligible for a randomized controlled trial. They did note that there were missing data on some covariates and that the missing data could introduce a bias in estimates.

However, the findings show that secukinumab had a greater persistence rate than ustekinumab in treating PsA, the researchers wrote.

“This study could help the rheumatologist choose the most adequate bDMARDs for patients with PsA in everyday practice,” they concluded.

Reference

Letarouilly J-G, Flachaire B, Labadie C, et al. Secukinumab and ustekinumab treatment in psoriatic arthritis: results of a direct comparison. Rheumatology (Oxford). Published online November 24, 2020. doi:10.1093/rheumatology/keaa710