Efficacy of secukinumab and adalimumab in patients with psoriatic arthritis and concomitant moderate-to-severe plaque psoriasis: results from EXCEED, a randomized, double-blind head-to-head monotherapy study

Background Secukinumab [an interleukin (IL)-17A inhibitor] has demonstrated significantly higher efficacy vs. etanercept (a tumour necrosis factor inhibitor) and ustekinumab (an IL-12/23 inhibitor) in patients with moderate-to-severe plaque psoriasis. Objectives To report 52-week results from a prespecified analysis of patients with active psoriatic arthritis (PsA) having concomitant moderate-to-severe plaque psoriasis from the head-to-head EXCEED monotherapy study comparing secukinumab with adalimumab. Methods Patients were randomized to receive secukinumab 300 mg via subcutaneous injection at baseline, week 1-4, and then every 4 weeks until week 48 or adalimumab 40 mg via subcutaneous injection every 2 weeks from baseline until week 50. Assessments in patients with concomitant moderate-to-severe psoriasis, defined as having affected body surface area > 10% or Psoriasis Area and Severity Index (PASI) >= 10 at baseline, included musculoskeletal, skin and quality-of-life outcomes. Missing data were handled using multiple imputation. Results Of the 853 patients [secukinumab (N = 426), adalimumab (N = 427)], 211 (24.7%) had concomitant moderate-to-severe psoriasis [secukinumab (N = 110, 25.8%), adalimumab (N = 101, 23.7%)]. Up to week 50, 5.5% of patients discontinued secukinumab vs.17.8% in the adalimumab group. The proportion of patients who achieved American College of Rheumatology (ACR) 20 response was 76.4% with secukinumab vs. 68.3% with adalimumab (P = 0.175), PASI 100 response was 39.1% vs. 23.8% (P = 0.013), and simultaneous improvement in ACR 50 and PASI 100 response at week 52 was 28.2% vs. 17.7%, respectively (P = 0.06). Secukinumab demonstrated consistently higher responses vs. adalimumab across skin endpoints. Conclusions This prespecified analysis in PsA patients with concomitant moderate-to-severe plaque psoriasis in the EXCEED study provides further evidence that IL-17 inhibitors offer a comprehensive biological treatment to manage the concomitant features of psoriasis and PsA.