Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen, Denmark.
Rheumatology (Oxford). 2021 Aug 2;60(8):3635-3645. doi: 10.1093/rheumatology/keaa825.
To compare treatment retention and response to secukinumab vs adalimumab, including the other four TNF inhibitors (TNFi) as comparators, in PsA.
All patients with PsA starting secukinumab or a TNFi in 2015-2018 were identified in the biologic registers of the Nordic countries. Data on comorbidities were linked from national registers. One-year treatment retention and hazard ratios (HRs) for treatment discontinuation were calculated. The proportion achieving a 6 month 28-joint Disease Activity Index for Psoriatic Arthritis (DAPSA28) remission was determined together with odds ratios (ORs) for remission (logistic regression). Both HRs and ORs were calculated with adalimumab as the reference and adjusted for baseline characteristics and concurrent comorbidities. All analyses were stratified by the line of biologic treatment (first, second, third+).
We identified 6143 patients contributing 8307 treatment courses (secukinumab, 1227; adalimumab, 1367). Secukinumab was rarely used as the first biologic, otherwise baseline characteristics were similar. No clinically significant differences in treatment retention or response rates were observed for secukinumab vs adalimumab. The adjusted HRs for discontinuation per the first, second and third line of treatment were 0.98 (95% CI 0.68, 1.41), 0.94 (0.70, 1.26) and 1.07 (0.84, 1.36), respectively. The ORs for DAPSA28 remission in the first, second and third line of treatment were 0.62 (95% CI 0.30, 1.28), 0.85 (0.41, 1.78) and 0.74 (0.36, 1.51), respectively. In the subset of patients previously failing a TNFi due to ineffectiveness, the results were similar.
No significant differences in treatment retention or response were observed between secukinumab and adalimumab, regardless of the line of treatment. This suggests that even in patients who have failed a TNFi, choosing either another TNFi or secukinumab may be equally effective.
比较司库奇尤单抗与阿达木单抗（包括其他四种 TNF 抑制剂（TNFi）作为对照）治疗银屑病关节炎（PsA）的治疗保留率和应答率。
在北欧国家的生物制剂登记处中确定了 2015-2018 年开始使用司库奇尤单抗或 TNFi 的所有 PsA 患者。从国家登记处链接了合并症数据。计算了 1 年治疗保留率和治疗中断的风险比（HRs）。确定了达到 6 个月银屑病关节炎 28 个关节疾病活动度评分（DAPSA28）缓解的比例，并使用逻辑回归确定缓解的优势比（ORs）。均使用阿达木单抗作为参考，根据基线特征和合并症进行调整，计算 HRs 和 ORs。所有分析均按生物治疗线（一线、二线、三线+）分层。
我们确定了 6143 名患者，共提供了 8307 个治疗疗程（司库奇尤单抗 1227 个，阿达木单抗 1367 个）。司库奇尤单抗很少作为一线生物制剂使用，否则基线特征相似。与阿达木单抗相比，司库奇尤单抗在治疗保留率或应答率方面没有观察到临床意义上的差异。按一线、二线和三线治疗的调整 HR 分别为 0.98（95%CI 0.68, 1.41）、0.94（0.70, 1.26）和 1.07（0.84, 1.36）。在一线、二线和三线治疗中，DAPSA28 缓解的 OR 分别为 0.62（95%CI 0.30, 1.28）、0.85（0.41, 1.78）和 0.74（0.36, 1.51）。在因无效而先前失败于 TNFi 的患者亚组中，结果相似。
无论治疗线如何，司库奇尤单抗与阿达木单抗在治疗保留率或应答率方面均无显著差异。这表明，即使在先前因 TNFi 治疗失败的患者中，选择另一种 TNFi 或司库奇尤单抗可能同样有效。
