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. 2018 Feb 12:2:3.
doi: 10.1186/s41927-018-0011-1. eCollection 2018.

Network meta-analysis and cost per responder of targeted Immunomodulators in the treatment of active psoriatic arthritis

Vibeke Strand  1 , M Elaine Husni  2 , Keith A Betts  3 , Yan Song  4 , Rakesh Singh  5 , Jenny Griffith  5 , Marci Beppu  5 , Jing Zhao  4 , Arijit Ganguli  5
Affiliations

Network meta-analysis and cost per responder of targeted Immunomodulators in the treatment of active psoriatic arthritis

Vibeke Strand et al. BMC Rheumatol. .

Abstract

Background: Multiple targeted immunomodulators (TIMs) for psoriatic arthritis (PsA) treatment are available, but limited studies have directly compared these agents. This study indirectly compared the efficacy of TNF-α, interleukins, and phosphodiesterase-4 inhibitors for treatment of active PsA.

Methods: A systematic literature review was conducted to identify phase III randomized controlled trials (RCTs) for adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, ustekinumab, secukinumab, and apremilast in active PsA. Joint (ACR20/50/70) and skin outcomes (PASI75/90) at Week 24 with each TIM were estimated via a Bayesian network meta-analysis, and the incremental cost per responder over the first 24 weeks of treatment was calculated. Similar analyses were conducted in a subgroup of biologic-naïve patients.

Results: Seventeen RCTs were identified; 13 included ACR and/or PASI responses at Week 24. Among the overall population, patients receiving adalimumab, golimumab, and infliximab showed higher ACR20/50/70 (adalimumab: 61.2/42.8/40.8%, golimumab: 61.6/39.8/27.4%, infliximab: 56.2/57.1/34.2%) and PASI75/90 (72.7/55.5%, 74.1/57.2%, and 77.1/61.0%, respectively) responses at Week 24 compared with other TIMs. In terms of cost-effectiveness, these treatments were also associated with the lowest incremental cost per responder for both skin and joint outcomes. Similar rankings of efficacy and incremental cost per responder were observed in the analysis among biologic-naive patients.

Conclusions: Adalimumab, golimumab, and infliximab were associated with higher efficacy and lower incremental costs per responder for both joint and skin responses in active PsA.

Keywords: Arthritis, psoriatic; Cost-benefit analysis; Immunomodulators; Meta-analysis.

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Conflict of interest statement

Not applicableNot applicableVS has served as consultant to AbbVie, Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Celltrion, Genentech / Roche, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Sandoz, UCB; MH, KB, YS, and JZ have served as consultants to AbbVie. RS, JG, MB, and AG are employees of AbbVie and may own company stock.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Evidence network for ACR and PASI outcomes among the overall population. a Thirteen trials reported ACR responses at Week 24 were selected: ADEPT [34], PALACE 1 [39], PALACE 2 [40], PALACE 3 [–43], PALACE 4 [44, 45], RAPID-PsA [46], Mease 2004 [25], GO-REVEAL [47], IMPACT 2 [48], FUTURE 1 [49], FUTURE 2 [50], PSUMMIT 1 [51], and PSUMMIT 2 [52]. (b) Eleven trials reported PASI responses at Week 24 were selected: ADEPT [34], PALACE 1 [39], PALACE 3 [–43], RAPID-PsA [46], Mease 2004 [25], GO-REVEAL [47], IMPACT 2 [48], FUTURE 1 [49], FUTURE 2 [50], PSUMMIT 1 [51], and PSUMMIT 2 [52].
Fig. 2
Fig. 2
Incremental cost per responder over 24 weeks among the overall population. a Incremental cost per additional ACR50 responder vs. incremental cost per additional PASI75 responder. b Incremental cost per additional ACR70 responder vs. incremental cost per additional PASI90 responder. ADA, adalimumab; APR, apremilast; CZP, certolizumab pegol; ETN, etanercept; GOL, golimumab; IFX, infliximab; SEC 150, secukinumab 150 mg; SEC 300, secukinumab 300 mg; UST 45, ustekinumab 45 mg; UST 90, ustekinumab 90 mg
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