Main trial data from the head-to-head EXCEED trial showed that, for patients who suffer from psoriatic arthritis and who are biologic-naïve, secukinumab monotherapy does not offer greater musculoskeletal benefits than adalimumab .
The EXCEED trial is a phase 3b study of patients with active psoriatic arthritis and an inadequate response or intolerance to conventional disease-modifying anti-rheumatic drugs (DMARDs). The trial compared secukinumab and adalimumab as first-line biologic monotherapy through 52 weeks, with a musculoskeletal primary endpoint.
A total of 853 patients were randomised to secukinumab 300 mg/week at weeks 0-4 and every 4 weeks thereafter (n=426) or adalimumab 40 mg subcutaneous at baseline and then every 2 weeks until week 50 (n=427). Baseline demographics and disease characteristics were comparable between treatment-groups apart from the fact that the secukinumab group held a higher proportion of female patients as well as patients without enthesitis.
Results showed that ACR20 response at week 52 was achieved by 67.4% of secukinumab-treated patients versus 61.5% of adalimumab-treated patients (P=0.0719). As the primary endpoint was not met, key secondary endpoints were not formally evaluated for statistical significance. However, it was clear that a PASI90 skin response was achieved by more secukinumab-treated patients than those treated with adalimumab (65% vs 43%, respectively). Also, a simultaneous ACR50 and PASI100 response was achieved by 31% of secukinumab-treated patients versus 19% of adalimumab-treated patients. Another difference between the groups concerned treatment discontinuation rates (14% with secukinumab vs 24% with adalimumab). The most important reasons for discontinuation were patient or guardian decision, adverse events, and lack of efficacy.
1. McInnes IB, et al. Secukinumab versus adalimumab for treatment of active psoriatic arthritis (EXCEED): a double-blind, parallel-group, randomised, active-controlled, phase 3b trial. OP0227. EULAR 2020.