Observational Study Finds Abatacept, Apremilast Inferior to Adalimumab for PsA
Despite a relatively fast uptake of newer biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for psoriatic arthritis (PsA) in Nordic countries, outcomes with some of the newer options were lackluster compared with adalimumab. Researchers published their findings in the Annals of the Rheumatic Diseases.
“Our results showed differences in outcomes across the treatment options, where abatacept and apremilast seemed to have inferior effectiveness compared with adalimumab, while ixekizumab, secukinumab and tofacitinib performed similar to adalimumab, and ustekinumab somewhere in between,” wrote study corresponding author Bente Glintborg, MD, PhD, of Copenhagen University Hospital Glostrup in Denmark, and coauthors.
The observational study included patients from five Nordic rheumatology registers who started a b/tsDMARD for PsA between 2012 and 2020. Researchers investigated treatment retention and response to abatacept, apremilast, ixekizumab, secukinumab, tofacitinib, and ustekinumab compared with adalimumab. The analysis included 5659 adalimumab treatment courses and 4767 newer b/tsDMARD courses.
Beginning in 2014, patient uptake of newer b/tsDMARDs increased rapidly until hitting a plateau in 2018, according to the study. Adalimumab was used more frequently as a first course of treatment. Newer b/tsDMARDs were used more often in biologic-experienced patients, researchers reported.
As a second/third b/tsDMARD, adalimumab had significantly better 1-year retention and 6-month effectiveness than several newer options, the study showed. Retention and effectiveness, as gauged by the proportion of patients achieving low disease activity at 6 months on the Disease Activity Index for PsA based on 28-joint evaluation, were 65% and 59%, respectively, with adalimumab. In comparison, 1-year retention rate with abatacept was 45%, and 37% of patients achieved low disease activity at 6 months. Retention with apremilast was 43%, and 35% achieved low disease activity. For both ixekizumab and ustekinumab, low disease activity rates were achieved by 40% of patients, but retention rates were 65% with ixekizumab and 58% with ustekinumab.
Retention and effectiveness did not significantly differ between adalimumab and secukinumab or tofacitinib, researchers reported.
“Regardless of mode of action, only a minority of patients starting a second or later b/tsDMARD course remained on drug and achieved low disease activity,” they wrote. “Superior outcomes for adalimumab indicate that the positioning of newer b/tsDMARDs in the PsA treatment algorithm remains to be established.”
—Jolynn Tumolo
Reference:
Glintborg B, Di Giuseppe D, Wallman JK, et al. Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries. Ann Rheum Dis. 2023;82(6):820-828. doi:10.1136/ard-2022-223650
