J Rheum Dis.  2017 Aug;24(4):211-219. 10.4078/jrd.2017.24.4.211.

Comparative Efficacy and Safety of Secukinumab and Adalimumab in Patients with Active Ankylosing Spondylitis: A Bayesian Network Meta-analysis of Randomized Controlled Trials

• Lee YH
• Song GG

• KMID: 2389062
• DOI: http://doi.org/10.4078/jrd.2017.24.4.211

Abstract

OBJECTIVE
This study assessed the efficacy and safety of secukinumab and adalimumab in patients with active ankylosing spondylitis (AS).
METHODS
A Bayesian network meta-analysis was performed with direct and indirect data collected from randomized controlled trials (RCTs) of efficacy and safety of secukinumab 75 mg, 150 mg and adalimumab 40 mg in patients with active AS.
RESULTS
Five RCTs (1,483 patients) met the inclusion criteria. The Assessment in Spondyloarthritis International Society response criteria of ≥20% (ASAS20) response rate was significantly higher in the adalimumab 40 mg (Odds ratio [OR], 4.26; 95% credible interval [CrI], 2.09~8.08), secukinumab 150 mg (OR, 3.35; 95% CrI, 1.73~6.56), and 75 mg dose (OR, 2.44; 95% CrI, 1.06~5.05) than with placebo. The ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that adalimumab 40 mg had the highest probability of being the best treatment for achieving an ASAS20 response (SUCRA=0.8753), followed by secukinumab 150 mg (SUCRA=0.7051), secukinumab 75 mg (SUCRA=0.4113), and placebo (SUCRA=0.0083). The ASAS40 response rate distribution pattern was similar to the ASAS20 response rate. However, the number of serious adverse events did not differ significantly among the treatment options.
CONCLUSION
Secukinumab and adalimumab were effective for the treatment of active AS without causing a significant risk of serious adverse events.

Keyword

Secukinumab; Adalimumab; Ankylosing spondylitis; Network meta-analysis

MeSH Terms

Adalimumab*
Humans
Spondylitis, Ankylosing*
Adalimumab

Figure

• 

  Figure 1. Flow diagram of the study selection process. AS: ankylosing spondylitis.

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  Figure 2. Evidence network diagram of comparisons for network meta-analysis. The width of each edge is proportional to the number of randomized controlled trials comparing each pair of treatments, and the size of each treatment node is proportional to the number of randomized participants (sample size). (A) Placebo. (B) Secukinumab 150 mg. (C) Secukinumab 75 mg. (D) Adalimumab 40 mg.

• 

  Figure 3. Results of the Bayesian network meta-analysis of randomized controlled studies on the relative efficacy (A: ASAS20, B: ASAS40) and safety (C) of secukinumab and adalimumab. ASAS: Assessment in Spondyloarthritis International Society, OR: odds ratio, CrI: credible interval.

• 

  Figure 4. Inconsistency plot for the efficacy (A: ASAS20, B: ASAS40) and safety (C) of secukinumab and adalimumab. Plot of the individual data points' posterior mean deviance contributions for the consistency model (horizontal axis) and the unrelated mean effects model (vertical axis) along with the line of equality. ASAS: Assessment in Spondyloarthritis International Society.

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