Which PsA Biologic Is Safer, More Effective?



A recent meta-analysis found no differences in the safety and efficacy of non-anti-tumor necrosis factor α (TNF-α) biologics for the treatment of moderate to severe psoriatic arthritis (PsA).

In their systematic review, the researchers identified 8 randomized controlled trials that assessed the efficacy and safety of abatacept, apremilast, secukinumab, and ustekinumab among adults with moderate to severe PsA. They used the American College of Rheumatology criteria (ACR 20 and ACR 50) and psoriasis area and severity index (PASI and PASI75) to assess the efficacy of each therapy, and examined the prevalence of any adverse events and serious adverse events.

The researchers found significant differences in the ACR20 response rate among patients who received 150 mg of secukinumab compared with those who received 20 mg of apremilast (relative risk [RR] 2.55; CI=1.24-5.23) and between those who received 300 mg of secukinumab compared with those who received 20 or 30 mg of apremilast (RR 3.57, CI= 1.48-8.64 and RR 2.84 CI=1.18-6.86, respectively).

Patients who received 20 or 30 mg of apremilast experienced more adverse events compared with placebo and 150 mg of secukinumab. However, there were not significant differences in serious adverse events among biologics and between biologics and placebo.

Additionally, 150 mg and 300 mg doses of secukinumab were associated with the highest rank for the ACR20 endpoint among the overall patient population and a subpopulation of anti-TNF-α-naive patients. Among anti-TNF-α-experienced patients, 300 mg of secukinumab and 30 mg of apremilast were associated with the highest rank.

While 75 mg of secukinumab had the lowest rate for any adverse events, 90 mg of ustekinumab had the lowest for rate for serious adverse events.

“Our study revealed no significant differences among non-anti-TNF-α biologics in the treatment of PsA in the comparisons performed with regards to the highest efficacy and safety,” the researchers concluded. “Head-to-head trials and evaluation of comparative efficacy and safety between non-TNF-α biologics are warranted to inform clinical decision making with a relevant treatment paradigm.”

Melissa Weiss


Kawalec P, Holko P, Moćko P, Pilc A. Comparative effectiveness of abatacept, apremilast, secukinumab and ustekinumab treatment of psoriatic arthritis: a systematic review and network meta-analysis [published online December 28, 2017]. Rheumatol Int. https://doi.org/10.1007/s00296-017-3919-7.