OBJECTIVES:

: When populations across different trials are heterogeneous, Matching-Adjusted Indirect Comparison (MAIC) can be used to assess comparative effectiveness; it is supported by NICE DSU methodological guidance.

The objective of this MAIC was to assess the comparative effectiveness of secukinumab 150mg (SEC; fully human anti-interleukin-17A) and etanercept 25mg twice weekly (ETN; tumor necrosis factor inhibitor [TNFi]) up to 24 weeks in biologic-naïve patients with psoriatic arthritis (PsA).

METHODS:

: In this MAIC, individual patient data from the pooled SEC arms of FUTURE 1 (F1) and FUTURE 2 (F2; n=302) were weighted to match baseline characteristics of the ETN arm of NCT00317499 (n=101); placebo arms were also matched. Before matching, one notable difference was the proportion of biologic-naïve patients (67.2% [F1/F2] versus 100% [NCT00317499]). Logistic regression was used to determine weights for age, body weight, sex, race, PsA disease duration, presence of psoriasis (≥3% body surface area), mean HAQ-DI score, swollen joint count (SJC), CRP, methotrexate use and previous TNFi therapy failure. Recalculated outcomes from F1/F2 (SEC, effective sample size [ESS]=79; placebo, ESS=94) were compared with NCT00317499. Pairwise comparisons using odds ratios (ORs) were performed for American College of Rheumatology (ACR) 20, 50 and 70 responses at week 12 (placebo-adjusted) and week 24 (non-placebo-adjusted). Placebo-adjustment at week 24 was not possible as patients could receive active treatment from week 16.

RESULTS:

: At week 12, no differences in placebo-adjusted ACR 20, 50 and 70 responses between SEC and ETN were observed. At week 24 (non-placebo-adjusted), ACR 70 responses were higher with SEC than ETN (OR [95% CI]: 3.06 [1.30–7.19], p= 0.010).

A sensitivity analysis excluding PsA disease duration, SJC and CRP from the matching confirmed these results.

CONCLUSIONS:

: In this MAIC, secukinumab showed evidence of superiority for symptomatic improvement (non-placebo-adjusted ACR 70) over etanercept for active PsA at 24 weeks.