Efficacy and Safety of Biologics to Treat Adults With Active Radiographic Axial Spondyloarthritis: Systematic Review and Bayesian Network Meta-Analysis
Author(s)
Andrei Lazarev, MS1, Daria Tolkacheva, MS1, Kirill Sapozhnikov, PhD1, Natalia Sableva, MS2, Olga Mironenko, PhD2, Daria Afanaseva, MS1.
1BIOCAD JSC, Saint Petersburg, Russian Federation, 2BIOCAD JSC, Moscow, Russian Federation.
1BIOCAD JSC, Saint Petersburg, Russian Federation, 2BIOCAD JSC, Moscow, Russian Federation.
OBJECTIVES: To compare efficacy and safety of IL-17 inhibitors in the treatment of adults with active radiographic axial spondyloarthritis (r-AxSpA) over a 16-week period using network meta-analysis (NMA).
METHODS: We conducted systematic literature search in PubMed and Embase in November 2024 to retrieve publications with results of randomized controlled trials (RCTs) evaluating efficacy and safety of IL-17 inhibitors (netakimab, secukinumab, ixekizumab, bimekizumab, brodalumab, xeligekimab, vunakizumab) in adults with active r-AxSpA. Primary endpoints were 16-week ASAS40 and frequency of adverse events (AEs). 16-week ASAS20, BASDAI, BASFI and SF-36 were selected as secondary outcomes. We performed Bayesian NMA with random effects. A baseline natural history model was used to adjust for between-study heterogeneity in placebo outcomes according to NICE TSD 5. Treatments were ranked by SUCRA (surface under the cumulative ranking curve).
RESULTS: We included 15 RCTs into NMA. Published full text results were not available for xeligekimab and vunakizumab, only conference posters with limited data. We identified moderate clinical heterogeneity and low risk of bias in included RCTs. Netakimab 120 mg Q2W is superior over the most treatment options by 16-week ASAS40 (Risk Ratio, 95% Credible Intervals): ixekizumab 80mg Q2W 1.59(1.04;2.74), bimekizumab 320mg Q4W 1.62(0.95;3.11), bimekizumab 160mg Q4W 1.70(1.07;3.00), bimekizumab 64mg Q4W 1.77(1.00;3.50), ixekizumab 80mg Q4W 1.72(1.12;2.93), secukinumab 300mg Q4W 1.93(1.09;3.82), secukinumab 150mg Q4W 1.87(1.22;3.20), brodalumab 210mg Q2W 2.06(1.07;4.48), secukinumab 3mg/kg Q4W 2.11(1.18;4.16), secukinumab 75mg Q4W 2.29(1.33;4.29), bimekizumab 16mg Q4W 2.69(1.27;6.10). Also Netakimab has comparable safety profile to all options. Top 3 IL-17 by SUCRA averaged over all endpoints are: netakimab 120mg Q2W(0.915), netakimab 80mg Q2W(0.79), and bimekizumab 320mg Q4W(0.645).
CONCLUSIONS: Netakimab showed the highest relative efficacy among available IL-17 inhibitors used to treat adults with active r-AxSpA over 16-week horizon and demonstrated a favorable safety profile.
METHODS: We conducted systematic literature search in PubMed and Embase in November 2024 to retrieve publications with results of randomized controlled trials (RCTs) evaluating efficacy and safety of IL-17 inhibitors (netakimab, secukinumab, ixekizumab, bimekizumab, brodalumab, xeligekimab, vunakizumab) in adults with active r-AxSpA. Primary endpoints were 16-week ASAS40 and frequency of adverse events (AEs). 16-week ASAS20, BASDAI, BASFI and SF-36 were selected as secondary outcomes. We performed Bayesian NMA with random effects. A baseline natural history model was used to adjust for between-study heterogeneity in placebo outcomes according to NICE TSD 5. Treatments were ranked by SUCRA (surface under the cumulative ranking curve).
RESULTS: We included 15 RCTs into NMA. Published full text results were not available for xeligekimab and vunakizumab, only conference posters with limited data. We identified moderate clinical heterogeneity and low risk of bias in included RCTs. Netakimab 120 mg Q2W is superior over the most treatment options by 16-week ASAS40 (Risk Ratio, 95% Credible Intervals): ixekizumab 80mg Q2W 1.59(1.04;2.74), bimekizumab 320mg Q4W 1.62(0.95;3.11), bimekizumab 160mg Q4W 1.70(1.07;3.00), bimekizumab 64mg Q4W 1.77(1.00;3.50), ixekizumab 80mg Q4W 1.72(1.12;2.93), secukinumab 300mg Q4W 1.93(1.09;3.82), secukinumab 150mg Q4W 1.87(1.22;3.20), brodalumab 210mg Q2W 2.06(1.07;4.48), secukinumab 3mg/kg Q4W 2.11(1.18;4.16), secukinumab 75mg Q4W 2.29(1.33;4.29), bimekizumab 16mg Q4W 2.69(1.27;6.10). Also Netakimab has comparable safety profile to all options. Top 3 IL-17 by SUCRA averaged over all endpoints are: netakimab 120mg Q2W(0.915), netakimab 80mg Q2W(0.79), and bimekizumab 320mg Q4W(0.645).
CONCLUSIONS: Netakimab showed the highest relative efficacy among available IL-17 inhibitors used to treat adults with active r-AxSpA over 16-week horizon and demonstrated a favorable safety profile.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO91
Topic
Clinical Outcomes, Health Technology Assessment, Study Approaches
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)