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Biologics or DMARDS: Which Induction Therapy Is Superior?

A recent systematic review found that several biologics, including adalimumab and infliximab, were safer and more effective than targeted disease-modifying antirheumatic drugs (DMARDS) as induction therapy for patients with psoriatic arthritis.

In the review, researchers analyzed data from 29 randomized clinical trials that included 10,204 participants with PsA and evaluated the safety and efficacy of 17 treatments. They compared and ranked therapies based on the American College of Rheumatology criteria response 20 (ACR20), 75% improvement on the Psoriasis Area and Severity Index (PASI75), and number of adverse events and serious adverse events.
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The researchers found that all treatments, expect clazakizumab, were more efficacious at achieving ACR20 and PASI75 compared with placebo during the 12- to 16-week induction period. While no significant difference was found for serious adverse events for all treatments, tofacitinib (Xeljanz), apremilast (Otezla), and ixekinumab (Taltz) at 80 mg every 2 weeks had higher rates of adverse events, the researchers observed.

Infliximab (Remicade), golimumab (Simponi), etanercept (Enbrel), adalimumab (Humira), guselkumab (Skyrizi), and secukinumab (Cosentyx) 300 mg had outperformed other therapies at achieving PASI71 and ACR20 in meta-analysis. In addition, infliximab, guselkumab, adalimumab, golimumab, secukinumab (300 mg and 150 mg), and ustekinumab (Stelara; 45 mg and 90 mg) were highly efficacious and safe, the researchers said.

In analysis of biologic-naïve patients, ustekinumab, secukinumab (300 mg and 150 mg), ixekizumab, abatacept (Orencia), certolizumab pegol (Cimzia), tofacitinib, and apremilast treatment were associated with higher ACR20 compared with placebo. Ustekinumab, secukinumab (300 mg), ixekizumab, and tofacitinib were associated with higher PASI75 among participants who had received previous biologic therapy and/or had failed therapy.

“Regarding the overall risk-benefit profile, infliximab, guselkumab, adalimumab, golimumab, secukinumab, and ustekinumab may be safer and more efficacious treatments than the other targeted DMARDs for active PsA during induction therapy,” the researchers concluded.


Lu C, Wallace BI, Waljee AK, Fu W, Zhang Q, Liu Y. Comparative efficacy and safety of targeted DMARDs for active psoriatic arthritis during induction therapy: A systematic review and network meta-analysis [published online June 10, 2019]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2019.06.001

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