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Efficacy of Secukinumab Compared to Adalimumab in Patients With Psoriatic Arthritis

A Randomized, Double-blind, Active Control, Multicenter Study to Evaluate the Efficacy at Week 52 of Secukinumab Monotherapy Compared With Adalimumab Monotherapy in Patients With Active Psoriatic Arthritis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02745080
Acronym
EXCEED 1
Enrollment
853
Registered
2016-04-20
Start date
2017-04-03
Completion date
2019-12-30
Last updated
2021-01-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Psoriatic Arthritis

Keywords

Psoriatic Arthritis, secukinumab, adalimumab, monoclonal antibody, CASPAR

Brief summary

This was a randomized, double-blind, active controlled, multicenter, parallel-group study evaluating secukinumab monotherapy and adalimumab monotherapy in approximately 850 patients with active psoriatic arthritis (PsA) who are naïve to biologic therapy and are intolerant or having inadequate response to conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs).

Detailed description

The total maximum study duration, including the screening period was up to 76 weeks. At Baseline, patients whose eligibility was confirmed were randomized to 1 of 2 groups (1:1): Group 1 (secukinumab 300 mg) or Group 2 (adalimumab 40 mg). In order to maintain the blind, both groups received 1 or 2 placebo s.c. injections to keep consistency in the number of injections at each dosing visit. Secukinumab (300 mg) was available in 2 x 1.0 mL pre-filled syringes (PFS) and adalimumab was available in 1 x 0.4 mL PFS. Placebo (1.0 and 0.5 mL PFS) was also available. Secukinumab 300 mg s.c injection (2 x 1 mL PFS) was administered at Baseline, Weeks 1, 2, 3 and 4, followed by dosing every 4 weeks to Week 48. Adalimumab 40 mg (1 x 0.4 mL PFS) was administered at Baseline followed by dosing every 2 weeks until Week 50.

Interventions

BIOLOGICALSecukinumab

Eligible subjects are randomized to one of two treatment arms in a 1:1 ratio

BIOLOGICALAdalimumab

Eligible subjects are randomized to one of two treatment arms in a 1:1 ratio

Sponsors

Novartis Pharmaceuticals
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

Key Inclusion Criteria: * Diagnosis of PsA classified by CASPAR * Rheumatoid factor and anti-CCP antibodies negative * Diagnosis of active plaque psoriasis, with at least one psoriatic plaque of \>= 2cm diameter or nail changes consistent with psoriasis or documented history of plaque psoriasis * Inadequate control of symptoms with NSAIDs * Inadequate control of symptoms with a conventional DMARD. Key

Exclusion criteria

* Pregnant or nursing women * Evidence of ongoing infectious or malignant process * Previous exposure to any biologic drug for Psoriatic Arthritis or Psoriasis * Subjects taking high potency opioid analgesics * Ongoing use of prohibited psoriasis treatments/medications * Previous treatment with any cell-depleting therapies including but not limited to anti-CD20 investigational agents.

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52Week 52Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The primary endpoint is the proportion of patients with monotherapy ACR20 response at Week 52 where monotherapy ACR20 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 20 (ACR20) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 50 (the last dosing visit) 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)

Secondary

MeasureTime frameDescription
Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52Week 52The PASI is a system used for assessing and grading the severity of psoriatic lesions. In the PASI system, the body is divided into 4 regions: the head, trunk, upper extremities, and lower extremities. Each of these areas were assessed separately for the percentage of the area involved, which translates to a numeric score that ranges from 0 to 6, and for erythema, induration, and scaling, which are each rated on a scale of 0 to 4. The PASI produces a numeric score that can range from 0 to 72. A higher score indicates more severe disease. A PASI 90 response represents participants who achieved at least a 90 percent improvement from baseline in the PASI score.
Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52Week 52Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The secondary endpoint is the proportion of patients with monotherapy ACR50 response at Week 52 where monotherapy ACR50 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 50 (ACR50) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 52 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)
Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52Baseline, Week 52The HAQ-DI assesses a subject's level of functional ability and includes questions of fine movements of the upper extremity, locomotor activities of the lower extremity, and activities that involve both upper and lower extremities. There are 20 questions in 8 categories of functioning including dressing, rising, eating, walking, hygiene, reach, grip and usual activities. The stem of each item asks 'Over the past week, are you able to... perform a particular task'. Each item is scored on a 4 point scale from 0 - 3, representing normal, no difficulty (0), some difficulty (1), much difficulty (2) and unable to do (3). The disability index score is calculated as the mean of the available category scores, ranging from 0 to 3. A negative change from baseline indicates improvement.
Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52Week 52Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Resolution was defined as the absence of recorded enthesitis; conducted by the study assessor.

Countries

Australia, Bulgaria, Canada, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Israel, Italy, Latvia, Lithuania, Netherlands, Poland, Portugal, Russia, Slovakia, South Korea, Spain, United Kingdom, United States

Participant flow

Recruitment details

This study was conducted at 161 centers in 26 countries worldwide: Australia, Bulgaria, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Israel, Italy, South Korea, Latvia, Lithuania, The Netherlands, Poland, Portugal, Russia, Slovakia, Spain, UK and USA.

Pre-assignment details

853 patients were randomized in a 1:1 ratio to receive secukinumab 300 mg (N=426) or adalimumab 40 mg (N=427); All randomized patients were analyzed for efficacy and safety.

Participants by arm

ArmCount
Secukinumab 300 mg s.c.
Secukinumab 300 mg administered at Baseline, Weeks 1, 2, 3 and 4, followed by dosing every 4 weeks until Week 48.
426
Adalimumab 40 mg s.c.
Adalimumab 40 mg administered at Baseline followed by dosing every 2 weeks until Week 50.
427
Total853

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event1321
Overall StudyLack of Efficacy1123
Overall StudyLost to Follow-up33
Overall StudyPhysician Decision30
Overall StudyProtocol Violation31
Overall StudyWithdrawal by Subject2241

Baseline characteristics

CharacteristicSecukinumab 300 mg s.c.Adalimumab 40 mg s.c.Total
Age, Continuous48.5 Years
STANDARD_DEVIATION 12.38
49.5 Years
STANDARD_DEVIATION 12.44
49.0 Years
STANDARD_DEVIATION 12.41
Race/Ethnicity, Customized
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race/Ethnicity, Customized
Asian
16 Participants20 Participants36 Participants
Race/Ethnicity, Customized
Black or African American
3 Participants2 Participants5 Participants
Race/Ethnicity, Customized
Other
4 Participants8 Participants12 Participants
Race/Ethnicity, Customized
Unknown
1 Participants5 Participants6 Participants
Race/Ethnicity, Customized
White
402 Participants391 Participants793 Participants
Sex: Female, Male
Female
218 Participants198 Participants416 Participants
Sex: Female, Male
Male
208 Participants229 Participants437 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
1 / 4260 / 4271 / 853
other
Total, other adverse events
226 / 426236 / 427462 / 853
serious
Total, serious adverse events
37 / 42636 / 42773 / 853

Outcome results

Primary

Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 52

Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The primary endpoint is the proportion of patients with monotherapy ACR20 response at Week 52 where monotherapy ACR20 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 20 (ACR20) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 50 (the last dosing visit) 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)

Time frame: Week 52

Population: Full Analysis Set (FAS)

ArmMeasureValue (NUMBER)
Secukinumab 300 mg s.c.Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 5267.4 Percentage of Participants
Adalimumab 40 mg s.c.Percentage of Participants Who Achieved an American College of Rheumatology 20% (ACR20) Response at Week 5261.5 Percentage of Participants
p-value: 0.071995% CI: [0.98, 1.72]Regression, Logistic
Secondary

Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52

The HAQ-DI assesses a subject's level of functional ability and includes questions of fine movements of the upper extremity, locomotor activities of the lower extremity, and activities that involve both upper and lower extremities. There are 20 questions in 8 categories of functioning including dressing, rising, eating, walking, hygiene, reach, grip and usual activities. The stem of each item asks 'Over the past week, are you able to... perform a particular task'. Each item is scored on a 4 point scale from 0 - 3, representing normal, no difficulty (0), some difficulty (1), much difficulty (2) and unable to do (3). The disability index score is calculated as the mean of the available category scores, ranging from 0 to 3. A negative change from baseline indicates improvement.

Time frame: Baseline, Week 52

Population: Full Analysis Set (FAS)

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
Secukinumab 300 mg s.c.Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52-0.58 Unit on a scaleStandard Error 0.027
Adalimumab 40 mg s.c.Change From Baseline in Health Assessment Questionnaire - Disability Index (HAQ-DI Score) at Week 52-0.56 Unit on a scaleStandard Error 0.027
p-value: 0.546595% CI: [-0.1, 0.05]Mixed Models Analysis
Secondary

Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 52

Clinical response, failure to permanently discontinue study medication prematurely, and lack of need for rescue medication was required for a patient to achieve treatment success. The secondary endpoint is the proportion of patients with monotherapy ACR50 response at Week 52 where monotherapy ACR50 response is defined as meeting the following 3 conditions: 1. achieving American College of Rheumatology 50 (ACR50) response 2. no permanent study treatment (secukinumab or adalimumab) discontinuation before or at Week 52 3. no use of conventional disease modifying anti-rheumatic drugs (also known as non-biologic DMARDs) cDMARDs (including Methotrexate (MTX)) after Week 36 (regardless of the starting time of taking cDMARDs)

Time frame: Week 52

Population: Full Analysis Set (FAS)

ArmMeasureValue (NUMBER)
Secukinumab 300 mg s.c.Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 5249.0 Percentage of Participants
Adalimumab 40 mg s.c.Percentage of Participants Who Achieved an American College of Rheumatology 50% (ACR50) Response at Week 5244.8 Percentage of Participants
p-value: 0.225195% CI: [0.9, 1.55]Regression, Logistic
Secondary

Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 52

The PASI is a system used for assessing and grading the severity of psoriatic lesions. In the PASI system, the body is divided into 4 regions: the head, trunk, upper extremities, and lower extremities. Each of these areas were assessed separately for the percentage of the area involved, which translates to a numeric score that ranges from 0 to 6, and for erythema, induration, and scaling, which are each rated on a scale of 0 to 4. The PASI produces a numeric score that can range from 0 to 72. A higher score indicates more severe disease. A PASI 90 response represents participants who achieved at least a 90 percent improvement from baseline in the PASI score.

Time frame: Week 52

Population: Psoriasis Subset of the Full Analysis Set (FAS)

ArmMeasureValue (NUMBER)
Secukinumab 300 mg s.c.Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 5265.4 Percentage of Participants
Adalimumab 40 mg s.c.Percentage of Participants Who Achieved a Psoriasis Area and Severity Index (PASI)-90 Response at Week 5243.2 Percentage of Participants
p-value: <0.000195% CI: [1.67, 3.71]Regression, Logistic
Secondary

Percentage of Participants Who Achieved Resolution of Enthesitis at Week 52

Enthesitis refers to inflammation of entheses, the site where ligaments or tendons insert into the bones. Resolution was defined as the absence of recorded enthesitis; conducted by the study assessor.

Time frame: Week 52

Population: Enthesitis Subset (LEI) of the Full Analysis Set (FAS)

ArmMeasureValue (NUMBER)
Secukinumab 300 mg s.c.Percentage of Participants Who Achieved Resolution of Enthesitis at Week 5260.5 Percentage of Participants
Adalimumab 40 mg s.c.Percentage of Participants Who Achieved Resolution of Enthesitis at Week 5254.2 Percentage of Participants
p-value: 0.149895% CI: [0.91, 1.87]Regression, Logistic

Source: ClinicalTrials.gov · Data processed: Mar 1, 2026