Comparative effectiveness of secukinumab and adalimumab in ankylosing spondylitis as assessed by matching-adjusted indirect comparison

Abstract

ObjectiveMatching-adjusted indirect comparison was used to assess the comparative effectiveness of secukinumab 150 mg and adalimumab 40 mg in biologic-naïve patients with ankylosing spondylitis (AS) for up to 1 year.MethodsPooled individual patient data from the secukinumab arms of MEASURE 1 (NCT01358175) and MEASURE 2 (NCT01649375) trials (n=197) were matched against the ATLAS (NCT00085644) adalimumab population (n=208). Logistic regression analysis was used to determined weights to match for age, sex, Bath AS Functional Index, C-reactive protein levels, and previous tumor necrosis factor inhibitor therapy. Recalculated Assessment of SpondyloArthritis International Society (ASAS) 20 and 40 responses at weeks 8, 12, 16, 24, and 52 from MEASURE 1/2 (effective sample size=120) were compared with those of ATLAS. Anchored (placebo-adjusted) comparisons were possible until week 12, and unanchored (non-placebo-adjusted) comparisons were necessary thereafter.ResultsFor placebo-anchored ASAS 20 and 40 comparisons up to week 12, there were no differences between secukinumab and adalimumab. For unanchored comparisons at week 16, ASAS 20 was higher for secukinumab [odds ratio 1.60 (95% confidence interval, 1.01–2.54); p=0.047]; at week 24, ASAS 20 and 40 were higher for secukinumab [1.76 (1.11–2.79); p=0.017 and 1.79 (1.14–2.82); p=0.012, respectively]; and at week 52, ASAS 40 was higher for secukinumab [1.54 (1.06–2.23); p=0.023] than for adalimumab.ConclusionThere were no differences observed in placebo-adjusted ASAS 20 and 40 responses up to 12 weeks between secukinumab- and adalimumab-treated patients with ankylosing spondylitis. After week 12, secukinumab demonstrated signs of greater improvement in non-placebo-adjusted ASAS 20 and 40 responses than adalimumab.

A cost per responder analysis of secukinumab vs adalimumab for the treatment of ankylosing spondylitis from the Korean perspective

“…Thus, in this study, we analyzed only the data from biologic‐naïve patients to identify the efficacy of secukinumab as the primary biologic agent and found that efficacy of secukinumab was consistently comparable with adalimumab. This finding is consistent with the results of a recently published matching‐adjusted indirect comparison study that showed no significant differences in ASAS 20 and 40 response rates between secukinumab and adalimumab …”

“…25 Thus, in this study, we analyzed only the data from comparison study that showed no significant differences in ASAS 20 and 40 response rates between secukinumab and adalimumab. 26 The national health insurance of South Korea is operated by the government and offers universal coverage. 27 Therefore, verification of macro-cost-effectiveness is very important to national budget management for health care.…”

Secukinumab: A Review in Ankylosing Spondylitis

“…To date, no randomized controlled trials have directly compared secukinumab with other pharmacological agents in patients with AS. Matching-adjusted indirect comparisons have demonstrated no apparent differences in efficacy between secukinumab and adalimumab [ 45 ] or between secukinumab and golimumab [ 46 ] in placebo-anchored ASAS20/40 comparisons. In non-placebo-anchored analyses, secukinumab demonstrated higher ASAS20/40 response rates than adalimumab after week 12 [ 45 ] and golimumab at week 24 [ 46 ].…”

“…Matching-adjusted indirect comparisons have demonstrated no apparent differences in efficacy between secukinumab and adalimumab [ 45 ] or between secukinumab and golimumab [ 46 ] in placebo-anchored ASAS20/40 comparisons. In non-placebo-anchored analyses, secukinumab demonstrated higher ASAS20/40 response rates than adalimumab after week 12 [ 45 ] and golimumab at week 24 [ 46 ]. However, given the limitations of indirect comparisons, these results should be interpreted with caution.…”

Evidence for the Use of Secukinumab in Patients with Radiographic and Non-radiographic Axial Spondyloarthritis in the Last 5 Years

“…As mentioned, there is currently only one direct head-to-head clinical study comparing outcomes in axSpA patients taking secukinumab versus those treated with the TNF inhibitor adalimumab, which is currently ongoing [ 22 ]. In the absence of direct comparisons, an indirect comparison of secukinumab and adalimumab was made using matching-adjusted data from the MEASURE 1 and 2 studies and from the ATLAS study with adalimumab [ 84 ]. There was no difference in ASAS20 or ASAS40 outcomes between secukinumab and adalimumab in the placebo-anchored comparison, but the unanchored comparisons significantly favored secukinumab for ASAS20 at weeks 16 and 24, and for ASAS40 at weeks 24 and 52 [ 84 ].…”