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Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments

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Title: Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments
Authors: Yiyi Wang, Yue Xiao, Lingyan Zhang, Furong Li, Hongxiang Hu, Xiya Peng, Jingya Gao, Min Yang, Wei Yan, Li Qiu, Wei Li
Source: Journal of Dermatological Treatment, Vol 35, Iss 1 (2024)
Publisher Information: Taylor & Francis Group, 2024.
Publication Year: 2024
Collection: LCC:Dermatology
Subject Terms: Psoriatic arthritis, secukinumab, adalimumab, clinical efficacy, ultrasound evaluation, Dermatology, RL1-803
More Details: Background and objectives: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder affecting 30% of psoriatic patients. Effective treatment, especially with biologics like IL-17 and TNF inhibitors, is vital for improving patient outcomes. This study aimed to compare the efficacy of secukinumab and adalimumab in PsA patients through clinical and ultrasonographic evaluations.Materials and methods: We enrolled 116 PsA patients, with 58 patients receiving secukinumab and 58 receiving adalimumab. Regular follow-ups were conducted at weeks 4, 12, 24, and 52. The primary outcome was the proportion of patients achieving at least a 20% improvement in the ACR response (ACR20) at week 12, with additional evaluations for axial arthritis, enthesitis, skin involvement, minimal disease activity, health assessment questionnaire, and ultrasound changes.Results: There was no significant difference in ACR20 response between the two groups at week 12 (OR: 0.59, 95% CI: 0.26–1.37, p = 0.22). However, secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR: 2.25, 95%CI: 1.07–4.74, p = 0.03), while adalimumab showed better improvement in ultrasound synovitis count (β: 0.94, 95%CI: 0.09–1.79, p = 0.03) and synovitis PD signal (β: 0.20, 95%CI: 0.03–0.36, p = 0.02).Conclusions: In conclusion, both treatments were highly effective for PsA, with secukinumab being more suitable for severe skin involvement and adalimumab for significant ultrasound-confirmed synovitis.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 09546634
1471-1753
0954-6634
Relation: https://doaj.org/toc/0954-6634; https://doaj.org/toc/1471-1753
DOI: 10.1080/09546634.2024.2411849
Access URL: https://doaj.org/article/bce3f39406de4523b9cb5314736aee95
Accession Number: edsdoj.bce3f39406de4523b9cb5314736aee95
Database: Directory of Open Access Journals
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  Value: <anid>AN0181738219;b9l01dec.24;2024Dec22.23:53;v2.2.500</anid> <title id="AN0181738219-1">Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments </title> <p>Background and objectives: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder affecting 30% of psoriatic patients. Effective treatment, especially with biologics like IL-17 and TNF inhibitors, is vital for improving patient outcomes. This study aimed to compare the efficacy of secukinumab and adalimumab in PsA patients through clinical and ultrasonographic evaluations.Materials and methods: We enrolled 116 PsA patients, with 58 patients receiving secukinumab and 58 receiving adalimumab. Regular follow-ups were conducted at weeks 4, 12, 24, and 52. The primary outcome was the proportion of patients achieving at least a 20% improvement in the ACR response (ACR20) at week 12, with additional evaluations for axial arthritis, enthesitis, skin involvement, minimal disease activity, health assessment questionnaire, and ultrasound changes.Results: There was no significant difference in ACR20 response between the two groups at week 12 (OR: 0.59, 95% CI: 0.26–1.37, p = 0.22). However, secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR: 2.25, 95%CI: 1.07–4.74, p = 0.03), while adalimumab showed better improvement in ultrasound synovitis count (β: 0.94, 95%CI: 0.09–1.79, p = 0.03) and synovitis PD signal (β: 0.20, 95%CI: 0.03–0.36, p = 0.02).Conclusions: In conclusion, both treatments were highly effective for PsA, with secukinumab being more suitable for severe skin involvement and adalimumab for significant ultrasound-confirmed synovitis.</p> <p>Keywords: Psoriatic arthritis; secukinumab; adalimumab; clinical efficacy; ultrasound evaluation</p> <hd id="AN0181738219-2">Introduction</hd> <p>Psoriatic arthritis (PsA) is a multifaceted inflammatory musculoskeletal disorder with significant clinical heterogeneity ([<reflink idref="bib1" id="ref1">1</reflink>], [<reflink idref="bib2" id="ref2">2</reflink>]). The conditions predominantly manifest across six core domains: peripheral arthritis, enthesitis, dactylitis, spondylitis, cutaneous psoriasis, and nail involvement ([<reflink idref="bib3" id="ref3">3</reflink>]). Approximately 30% of patients with psoriasis develop PsA, and recent data indicate an estimated PsA prevalence of 10.4% in Chinese psoriatic populations ([<reflink idref="bib4" id="ref4">4</reflink>], [<reflink idref="bib5" id="ref5">5</reflink>]). Initial symptoms of PsA commonly present as joint stiffness and tender and swollen joints. As the disease progresses, patients may experience irreversible joint destruction, which is intricately associated with reduced quality of life and substantial socioeconomic burdens ([<reflink idref="bib1" id="ref6">1</reflink>]). Consequently, prompt and effective management is essential to alleviate the symptoms and prevent further disease progression of PsA. Current guidelines endorse the application of biological disease-modifying anti-rheumatic drugs (bDMARDs) to achieve therapeutic goals ([<reflink idref="bib3" id="ref7">3</reflink>], [<reflink idref="bib6" id="ref8">6</reflink>]). Remarkably, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) provided domain-focused guidance, suggesting that tumor necrosis factor inhibitors (TNFi) and interleukin (IL)-17 inhibitors (IL-17i) are two subclasses of bDMARDs for comprehensive PsA management could be applied across all six core domains.</p> <p>Within the TNFi and IL-17i classes, secukinumab and adalimumab are exemplary monoclonal antibodies, respectively, and have garnered approval from the National Medical Products Administration (NMPA) for PsA. The EXCEED trial ([<reflink idref="bib7" id="ref9">7</reflink>]), a head-to-head randomized clinical trial (RCT), revealed that these two first-line biologics share comparable long-term efficacy in peripheral arthritis, as determined by clinical assessment. Nevertheless, the interpretations of these findings are constrained by research design and its geographical bounds. Furthermore, the clinical assessments alone have limitations in capturing the full scope of the disease. Musculoskeletal ultrasound imaging could effectively provide objective measures of inflammatory and structural changes ([<reflink idref="bib8" id="ref10">8</reflink>], [<reflink idref="bib9" id="ref11">9</reflink>]).</p> <p>In this study, we aim to compare the effectiveness of secukinumab and adalimumab in managing PsA through comprehensive clinical and ultrasonographic evaluations among the Chinese population.</p> <hd id="AN0181738219-3">Materials and methods</hd> <p></p> <hd id="AN0181738219-4">Study design and participants</hd> <p>This prospective cohort study is based on the PARWCH database ([<reflink idref="bib10" id="ref12">10</reflink>]). Patients with PsA attending the Department of Dermatology at West China Hospital between March 2020 and October 2022, who met all the following criteria, were consecutively included in the study: (i) aged at least 18 years old; (ii) with a confirmed diagnosis of PsA based on the Classification Criteria for Psoriatic Arthritis (CASPAR) ([<reflink idref="bib11" id="ref13">11</reflink>]); and (iii) receiving secukinumab or adalimumab treatment, with the medication choice collaboratively determined by the patient and clinician. Exclusion criteria included: (i) diagnosed with other forms of arthritis such as rheumatoid arthritis, osteoarthritis, gouty arthritis, ankylosing spondylitis, etc.; (ii) with the presence of hematological diseases, malignant tumors, or severe infectious disease; (iii) with significant hepatic, renal, or other visceral organ dysfunction; (iv) being pregnant or lactating, and (v) discontinued treatment during the study period.</p> <p>Ethical approval for this study was granted by the West China Hospital's ethics committee, affiliated with Sichuan University (approval number: 2020(<reflink idref="bib321" id="ref14">321</reflink>)), and it was duly registered with the Chinese Clinical Trial Registry (approval number: ChiCTR2300073642). All participants provided informed consent before partaking in the study.</p> <hd id="AN0181738219-5">Follow-up procedures</hd> <p>Eligible patients were classified into the secukinumab group (SEC) or adalimumab group (ADA) based on the medication they used and captured comprehensive baseline information. Patients in the SEC group received a 300 mg secukinumab subcutaneous injection at baseline, followed by doses at weeks 1, 2, 3, and 4, and subsequently every 4 weeks, while those in the ADA group was administered a 40 mg adalimumab subcutaneous injection every 2 weeks. Regular follow-ups and clinical reassessments took place at weeks 4, 12, 24, and 52. Ultrasound examinations were performed at baseline and week 52.</p> <hd id="AN0181738219-6">Clinical assessment</hd> <p>We performed comprehensive clinical assessment across 6 aspects: demographic information, disease-related histories, personal and family histories, previous treatments, physical examination, and laboratory tests.</p> <p>Demographic information includes sex, age, and body mass index (BMI). Regarding disease-related histories, we focused on disease course, onset age, onset order, as well as associated comorbidities, including hypertension, type 2 diabetes, cardiovascular diseases, uveitis, fatty liver, anxiety, and depression. Furthermore, we documented histories of smoking, alcohol, surgery, trauma, and familial occurrences of psoriasis and PsA. Moreover, we also recorded previous biological treatments.</p> <p>With respect to physical examination, skin, peripheral arthritis, enthesitis, and axial arthritis were fully evaluated for all participants at each follow-up. Psoriasis severity was determined using the Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA) score, as assessed by an experienced dermatologist. For patients with peripheral arthritis, we documented the 68/66 tender and swollen joint counts (TJCs and SJCs), along with both the patient's and physician's global assessments of disease activity and pain and the Health Assessment Questionnaire (HAQ). These indices are vital components of the American College of Rheumatology (ACR) criteria ([<reflink idref="bib12" id="ref15">12</reflink>]). Axial arthritis was defined as PsA patients who presented with inflammatory neck, back, or sacroiliac joint pain, with or without radiographic evidence of sacroiliitis ([<reflink idref="bib13" id="ref16">13</reflink>]). The Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS) of back pain, and patient's global disease assessment were evaluated for them, which contribute to the Assessment of SpondyloArthritis International Society (ASAS) response ([<reflink idref="bib12" id="ref17">12</reflink>]). Additionally, enthesitis was simply assessed using the Leeds Enthesitis Index (LEI). Standard laboratory tests were conducted and the established reference ranges are as follows: C-reactive protein (CRP) < 6 mg/L and erythrocyte sedimentation rate (ESR) < 21 mm/h.</p> <hd id="AN0181738219-7">Ultrasound examination</hd> <p>According to ultrasound examination protocol ([[<reflink idref="bib14" id="ref18">14</reflink>], [<reflink idref="bib16" id="ref19">16</reflink>], [<reflink idref="bib18" id="ref20">18</reflink>]]), three sonographers with over five years of expertise in musculoskeletal ultrasound imaging conducted comprehensive scans of all peripheral joints, entheses, tendons, and bursae in the enrolled patients. Prior to the study, all investigators agreed on the ultrasound scanning method and data interpretation. A diagnosis consistency test yielded a kappa value of 0.85, which indicates good consistency. Throughout the 30-min examination, the sonographers remained unaware of the subjects' clinical information.</p> <p>Using the Philips IU22 equipped with a high-frequency (12–5MHz) probe, both longitudinal and cross-sectional scans were performed at each site. The grayscale images revealed structural changes, with the gain adjusted to the highest sensitivity without introducing noise signals. The power Doppler (PD) images indicated the level of inflammatory activity, with the gain also set to maximum sensitivity to avoid Doppler artifacts and color overflow.</p> <p>The joints examined included the shoulders, elbows, wrists, metacarpophalangeal joints, finger and toe interphalangeal joints, hips, knees, ankles, tarsal joints, and metatarsophalangeal joints. The tendons assessed encompassed the long heads of the biceps brachii, supraspinatus, infraspinatus, teres minor, common extensor, common flexor, triceps, wrist and hand extensor and flexor tendons, gluteus medius, gluteus minor, iliotibial band, quadriceps, tibialis anterior, tibialis posterior, peroneal longus and brevis, Achilles tendons, plantar fascia, and toe flexor and extensor tendons. The bursae evaluated included the subacromial-subdeltoid, olecranon, gastrocnemius-semimembranosus, and posterior calcaneal bursae. All entheses around these scanned joints, tendons, and bursae were also examined.</p> <p>Ultrasound changes were categorized into inflammatory changes (synovitis, enthesitis, tenosynovitis, and bursitis) and structural changes (enthesophyte and bone erosion) ([<reflink idref="bib19" id="ref21">19</reflink>]). Synovitis was defined as the hypoechogenicity area of the joint cavity, while enthesitis included thickening, hypoechogenicity, and PD signal ([<reflink idref="bib19" id="ref22">19</reflink>], [<reflink idref="bib20" id="ref23">20</reflink>]). Bursitis and tenosynovitis were identified by hypoechogenicity area of bursae synovialis and tendon sheath, respectively ([<reflink idref="bib19" id="ref24">19</reflink>]). Furthermore, we evaluated the thickness and PD signal grade of the affected synovium using the following grading standard: grade 0 (no intraarticular blood flow signals), grade 1 (no more than three blood flow signals), grade 2 (a small amount of blood flow signals, the area was less than 50% of the synovial area), grade 3 (continuous blood flow signals, the area exceeded 50% of the synovial area) ([<reflink idref="bib19" id="ref25">19</reflink>]).</p> <hd id="AN0181738219-8">Outcomes</hd> <p>The primary outcome measured was the percentage of patients achieving at least a 20% improvement in the ACR response criteria (ACR20) at week 12. Key secondary outcomes included responses of PASI90/75, ACR50/70, ASAS20/40/70, the proportion of patients reaching Psoriatic Arthritis Response Criteria (PsACR) and Minimal Disease Activity (MDA), resolution of LEI, and the mean change from baseline in HAQ score, pain VAS, and back pain VAS at week 12. These responses and changes at other follow-up points were also evaluated as exploratory outcomes.</p> <p>Moreover, we also focused on ultrasound changes to compare the impact of remission on radiological progression between secukinumab and adalimumab. The primary ultrasound outcomes observed included the mean changes in the counts of synovitis, enthesitis, tenosynovitis, bursitis, enthesophytes, and bone erosion, as well as the mean changes in the average thickness and PD signal grade of the affected synovium.</p> <hd id="AN0181738219-9">Statistical analysis</hd> <p>Continuous variables were represented as mean (SD), while categorical variables were expressed as count (%). The Shapiro-Wilk test was employed to evaluate data normality, and Levene's test was used to assess variance homogeneity. When continuous variables adhered to a normal distribution and homoscedasticity, the t-test was conducted to compare differences between the SEC and ADA groups. If variables deviated from normal distribution but maintained homoscedasticity, the Welch's t-test was applied. For variables lacking both normal distribution and homoscedasticity, the Wilcoxon test was used. Categorical data comparisons between the two groups were performed using the Chi-square test.</p> <p>For the analysis of binary outcomes, we utilized logistic regression to compute odds ratios (ORs), 95% confidence intervals (CIs), and <emph>P</emph>-values for comparing secukinumab versus adalimumab. Regarding analyses of repeated measures continuous outcomes, we assessed between-group variances using a mixed-effects model repeated measures approach. This model incorporated treatment and assessment visit as factors, baseline values of the outcome values as covariates, and included interaction terms for treatment by assessment visit and baseline value of the outcome by assessment visit. Due to minimal missing data, we chose to delete the missing values during statistical analyses. Linear regression models were employed for ultrasound continuous outcomes, adjusting for baseline enthesitis count, synovitis count, synovitis average thickness, and synovitis average PD signal. We estimated beta coefficients (β) along with their corresponding 95% CIs.</p> <p>All analyses and plotting were executed using R (version 4.3.0). A <emph>P</emph> value of less than 0.05 was considered statistically significant.</p> <hd id="AN0181738219-10">Results</hd> <p></p> <hd id="AN0181738219-11">Study population characteristics</hd> <p>A total of 116 patients with PsA were enrolled in this study, with 58 patients in the SEC group and 58 patients in the ADA group. Comprehensive baseline information was documented for all participants. Of these, 113 patients adhered to the scheduled follow-ups at weeks 4, 12, 24, and 52, allowing for detailed longitudinal data collection. Notably, one patient in the SEC group did not complete the follow-ups at weeks 4, 12, and 52, while two patients in the ADA group missed the follow-ups at weeks 24 and 52. The baseline characteristics, detailed in Table 1, demonstrate a high degree of similarity and comparability between the two groups.</p> <p>Table 1. Baseline information of patients.</p> <p> <ephtml> <table><thead><tr><td>Variables</td><td>SEC (<italic>n</italic> = 58)</td><td>ADA (<italic>n</italic> = 58)</td><td><italic>P</italic>-value</td></tr></thead><tbody valign="top"><tr><td><bold>Demographic information</bold></td><td /><td /><td /></tr><tr><td> Sex, male</td><td char=".">38 (65.52)</td><td char=".">42 (72.41)</td><td char=".">0.55</td></tr><tr><td> Age, years</td><td char=".">42.74 (12.91)</td><td char=".">40.34 (11.20)</td><td char=".">0.29</td></tr><tr><td> BMI, kg/m<sup>2</sup></td><td char=".">23.80 (4.95)</td><td char=".">23.95 (4.11)</td><td char=".">0.86</td></tr><tr><td><bold>Disease duration</bold></td><td /><td /><td /></tr><tr><td> Psoriasis onset age, years</td><td char=".">27.66 (10.70)</td><td char=".">24.88 (11.00)</td><td char=".">0.18</td></tr><tr><td> Psoriasis duration, years</td><td char=".">15.09 (10.76)</td><td char=".">15.89 (10.26)</td><td char=".">0.40</td></tr><tr><td> PsA onset age, years</td><td char=".">38.64 (12.63)</td><td char=".">35.96 (10.64)</td><td char=".">0.41</td></tr><tr><td> PsA duration, years</td><td char=".">5.37 (9.06)</td><td char=".">4.35 (6.32)</td><td char=".">0.41</td></tr><tr><td><bold>Onset order</bold></td><td /><td /><td /></tr><tr><td> Skin lesions earlier than arthritis</td><td char=".">51 (87.93)</td><td char=".">50 (86.20)</td><td char=".">0.68</td></tr><tr><td> Arthritis earlier than skin lesions</td><td char=".">2 (3.45)</td><td char=".">4 (6.90)</td></tr><tr><td> Simultaneous onset</td><td char=".">5 (8.62)</td><td char=".">4 (6.90)</td></tr><tr><td><bold>Comorbidities</bold></td><td /><td /><td /></tr><tr><td> Hypertension</td><td char=".">7 (12.07)</td><td char=".">10 (17.24)</td><td char=".">0.60</td></tr><tr><td> Type 2 diabetes</td><td char=".">4 (6.90)</td><td char=".">2 (3.45)</td><td char=".">0.68</td></tr><tr><td> Cardiovascular disease</td><td char=".">2 (3.45)</td><td char=".">1 (1.72)</td><td char=".">1.00</td></tr><tr><td> Uveitis</td><td char=".">0 (0)</td><td char=".">3 (5.17)</td><td char=".">0.24</td></tr><tr><td> Fatty liver</td><td char=".">22 (37.93)</td><td char=".">20 (34.48)</td><td char=".">0.85</td></tr><tr><td> Anxiety</td><td char=".">2 (3.45)</td><td char=".">7 (12.07)</td><td char=".">0.17</td></tr><tr><td> Depression</td><td char=".">2 (3.45)</td><td char=".">4 (6.90)</td><td char=".">0.68</td></tr><tr><td><bold>Family histories</bold></td><td /><td /><td /></tr><tr><td> Psoriasis</td><td char=".">15 (25.86)</td><td char=".">15 (25.86)</td><td char=".">1.00</td></tr><tr><td> PsA</td><td char=".">4 (6.90)</td><td char=".">3 (5.17)</td><td char=".">1.00</td></tr><tr><td><bold>Personal histories</bold></td><td /><td /><td /></tr><tr><td> Smoking</td><td char=".">22 (37.93)</td><td char=".">24 (41.38)</td><td char=".">0.85</td></tr><tr><td> Alcohol</td><td char=".">16 (27.59)</td><td char=".">23 (39.66)</td><td char=".">0.24</td></tr><tr><td> Surgery</td><td char=".">23 (39.66)</td><td char=".">21 (36.21)</td><td char=".">0.85</td></tr><tr><td> Trauma</td><td char=".">11 (18.97)</td><td char=".">13 (22.41)</td><td char=".">0.82</td></tr><tr><td><bold>Biologicals history</bold></td><td char=".">17 (29.31)</td><td char=".">16 (27.59)</td><td char=".">1.00</td></tr><tr><td><bold>Subtype</bold></td><td /><td /><td /></tr><tr><td> Axial</td><td char=".">7 (12.07)</td><td char=".">2 (3.45)</td><td char=".">0.19</td></tr><tr><td> Peripheral</td><td char=".">18 (31.03)</td><td char=".">17 (29.31)</td></tr><tr><td> Mixed</td><td char=".">33 (56.90)</td><td char=".">39 (67.24)</td></tr><tr><td><bold>Nail involvement</bold></td><td /><td /><td /></tr><tr><td> Nail bed</td><td char=".">5 (8.62)</td><td char=".">3 (5.17)</td><td char=".">0.06</td></tr><tr><td> Nail matrix</td><td char=".">6 (10.34)</td><td char=".">17 (29.31)</td></tr><tr><td> Both</td><td char=".">19 (32.76)</td><td char=".">19 (32.76)</td></tr><tr><td> None</td><td char=".">28 (48.28)</td><td char=".">19 (32.76)</td></tr><tr><td><bold>Psoriasis severity</bold></td><td /><td /><td /></tr><tr><td> PASI</td><td char=".">7.29 (8.61)</td><td char=".">7.08 (9.83)</td><td char=".">0.42</td></tr><tr><td> BSA</td><td char=".">10.5 (17.59)</td><td char=".">11.57 (21.76)</td><td char=".">0.44</td></tr><tr><td><bold>HAQ</bold></td><td char=".">0.31 (0.68)</td><td char=".">0.26 (0.53)</td><td char=".">0.71</td></tr><tr><td><bold>Laboratory examinations</bold></td><td /><td /><td /></tr><tr><td> CRP, mg/L</td><td char=".">11.37 (13.76)</td><td char=".">18.28 (31.66)</td><td char=".">0.87</td></tr><tr><td> ESR, mm/h</td><td char=".">22.47 (22.80)</td><td char=".">21.09 (20.64)</td><td char=".">0.92</td></tr><tr><td><bold>Peripheral involvement*</bold></td><td /><td /><td /></tr><tr><td> TJC</td><td char=".">10.14 (14.30)</td><td char=".">11.98 (15.06)</td><td char=".">0.15</td></tr><tr><td> SJC</td><td char=".">3.18 (5.48)</td><td char=".">5.07 (6.94)</td><td char=".">0.07</td></tr><tr><td> Pain VAS</td><td char=".">5.06 (2.59)</td><td char=".">5.66 (2.48)</td><td char=".">0.29</td></tr><tr><td> Patient-reporting disease activity VAS</td><td char=".">6.33 (2.15)</td><td char=".">5.94 (2.31)</td><td char=".">0.46</td></tr><tr><td> Clinician-reporting disease activity VAS</td><td char=".">5.79 (1.92)</td><td char=".">5.29 (2.46)</td><td char=".">0.34</td></tr><tr><td> LEI</td><td char=".">0.51 (1.26)</td><td char=".">0.62 (1.23)</td><td char=".">0.60</td></tr><tr><td><bold>Axial involvement</bold>†</td><td /><td /><td /></tr><tr><td> BASFI</td><td char=".">2.01 (2.39)</td><td char=".">1.90 (2.15)</td><td char=".">0.94</td></tr><tr><td> BASDAI</td><td char=".">2.20 (2.77)</td><td char=".">2.56 (3.01)</td><td char=".">0.57</td></tr><tr><td> Back pain VAS</td><td char=".">2.79 (2.83)</td><td char=".">4.29 (3.03)</td><td char=".">0.03</td></tr></tbody></table> </ephtml> </p> <p>1 Continuous variables are presented as mean (SD), while categorial variables are presented as n (%). *51 patients in the SEC group and 56 patients in the ADA group are peripheral arthritis. †40 patients in the SEC group and 41 patients in the ADA group are axial arthritis. SEC, secukinumab; ADA, adalimumab; BMI, body mass index; PsA, psoriatic arthritis; PASI, Psoriasis Area and Severity Index; BSA, Body Surface Area; HAQ, Health Assessment Questionnaire; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; TJC, tender joint count; SJC, swollen joint count; VAS, Visual Analog Scale; LEI, Leeds Enthesitis Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index.</p> <hd id="AN0181738219-12">Clinical outcomes</hd> <p>Six aspects (peripheral arthritis, enthesitis, axial arthritis, skin, composite index, and functional assessment) were thoroughly evaluated at each time point to compare the treatment efficacy between secukinumab and adalimumab. The primary outcome of ACR20 response at week 12 did not show a significant difference between the two groups (OR: 0.59, 95%CI: 0.26–1.37, <emph>p</emph> = 0.22, Table 2). Similarly, other indexes for evaluating peripheral arthritis, including ACR50, ACR70, and PsARC responses at week 12, also did not show a statistically significant difference between the two groups, with ORs and 95% CIs of 0.82 (0.38–1.79), 1.16 (0.54–2.50), and 0.53 (0.22–1.26), respectively (Table 2). The mean change of LEI for both SEC and ADA groups was also not statistically significant (β: 0.19, 95%CI: −0.03–0.42, <emph>p</emph> = 0.09, Table 2).</p> <p>Table 2. Treatment efficacy and outcomes at week 12.</p> <p> <ephtml> <table><thead><tr><td>Variable</td><td>SEC</td><td>ADA</td><td>OR (95% CI)</td><td><italic>P</italic>-value</td></tr></thead><tbody valign="top"><tr><td><bold>Peripheral arthritis</bold></td><td><italic>n</italic> = 50</td><td><italic>n</italic> = 56</td><td /><td /></tr><tr><td> ACR20</td><td char=".">32 (64.0)</td><td char=".">42 (75.00)</td><td char=".">0.59 (0.26–1.37)</td><td char=".">0.22</td></tr><tr><td> ACR50</td><td char=".">28 (56.00)</td><td char=".">34 (60.71)</td><td char=".">0.82 (0.38–1.79)</td><td char=".">0.62</td></tr><tr><td> ACR70</td><td char=".">26 (52.00)</td><td char=".">27 (48.21)</td><td char=".">1.16 (0.54–2.50)</td><td char=".">0.70</td></tr><tr><td> PsARC</td><td char=".">33 (66.00)</td><td char=".">44 (78.57)</td><td char=".">0.53 (0.22–1.26)</td><td char=".">0.15</td></tr><tr><td> Change of pain VAS</td><td char=".">−3.07 (3.18)</td><td char=".">−3.82 (3.15)</td><td char=".">*0.39 (-0.43–1.20)</td><td char=".">0.35</td></tr><tr><td><bold>Enthesitis</bold></td><td><italic>n</italic> = 50</td><td><italic>n</italic> = 56</td><td /><td /></tr><tr><td> Change of LEI</td><td char=".">−0.18 (0.65)</td><td char=".">−0.50 (1.07)</td><td char=".">*0.19 (-0.03–0.42)</td><td char=".">0.09</td></tr><tr><td><bold>Axial arthritis</bold></td><td><italic>n</italic> = 39</td><td><italic>n</italic> = 41</td><td /><td /></tr><tr><td> ASAS20</td><td char=".">29 (74.36)</td><td char=".">34 (82.93)</td><td char=".">0.60 (0.20–1.77)</td><td char=".">0.35</td></tr><tr><td> ASAS40</td><td char=".">25 (64.10)</td><td char=".">31 (75.61)</td><td char=".">0.58 (0.22–1.52)</td><td char=".">0.26</td></tr><tr><td> ASAS70</td><td char=".">18 (46.15)</td><td char=".">23 (56.10)</td><td char=".">0.67 (0.28–1.62)</td><td char=".">0.37</td></tr><tr><td> Change of back pain VAS</td><td char=".">−1.81 (2.92)</td><td char=".">−3.37 (2.97)</td><td char=".">*0.04 (-0.77–0.84)</td><td char=".">0.93</td></tr><tr><td><bold>Skin</bold></td><td><italic>n</italic> = 57</td><td><italic>n</italic> = 58</td><td /><td /></tr><tr><td> PASI90</td><td char=".">34 (59.65)</td><td char=".">23 (39.66)</td><td char=".">2.25 (1.07–4.74)</td><td char=".">0.03</td></tr><tr><td> PASI75</td><td char=".">43 (75.44)</td><td char=".">31 (53.45)</td><td char=".">2.68 (1.21–5.92)</td><td char=".">0.02</td></tr><tr><td><bold>Composite index</bold></td><td><italic>n</italic> = 57</td><td><italic>n</italic> = 58</td><td /><td /></tr><tr><td> MDA</td><td char=".">35 (61.40)</td><td char=".">38 (65.52)</td><td char=".">0.84 (0.39–1.79)</td><td char=".">0.65</td></tr><tr><td><bold>Functional assessment</bold></td><td><italic>n</italic> = 57</td><td><italic>n</italic> = 58</td><td /><td /></tr><tr><td> Change of HAQ</td><td char=".">−0.27 (0.66)</td><td char=".">−0.21 (0.49)</td><td char=".">*0.06 (-0.02–0.14)</td><td char=".">0.12</td></tr></tbody></table> </ephtml> </p> <p>2 Continuous variables are presented as mean (SD), while categorial variables are presented as n (%). *Continuous variables were analyzed using mixed-effect model repeated measures with beta coefficients (β) along with their corresponding 95% CIs being presented. SEC, secukinumab; ADA, adalimumab; ACR, American College of Rheumatology; PsARC, Psoriatic Arthritis Response Criteria; VAS, Visual Analog Scale; LEI, Leeds Enthesitis Index; ASAS, Assessment of SpondyloArthritis International Society; PASI, Psoriasis Area and Severity Index; MDA, Minimal Disease Activity; HAQ, Health Assessment Questionnaire.</p> <p>Regarding axial arthritis, both secukinumab and adalimumab exhibited extremely similar improvements, with ASAS20, ASAS40, and ASAS70 responses being approximately equal at each time point (Figure 1, Table 2, Tables S1–3). MDA responses and changes in HAQ scores were also comparable between the two groups (Figure 1, Table 2, Tables S1–3). Notably, although without statistically significant, ADA demonstrated slightly greater improvement than SEC in alleviating peripheral arthritis pain (SEC vs. ADA, −3.07 vs. −3.82, Table 2) and back pain in patients with axial involvement (SEC vs. ADA, −1.81 vs. −3.37, Table 2). One clear finding was the superior efficacy of SEC in achieving PASI90 (OR: 2.25, 95%CI: 1.07–4.74, <emph>p</emph> = 0.03, Table 2) and PASI75 responses (OR: 2.68, 95%CI: 1.21–5.92, <emph>p</emph> = 0.02, Table 2) at week 12 compared to ADA. These results were consistently observed across all follow-up periods (Table 2, Tables S1–3).</p> <p>PHOTO (COLOR): Figure 1. Changes of clinical outcomes up to week 52. The clinical outcomes presented as response rates or changes of mean were presented at baseline, weeks 4, 12, 24, and 52. SEC, secukinumab; ADA, adalimumab; ACR, American College of Rheumatology; PsARC, Psoriatic Arthritis Response Criteria; VAS, Visual Analog Scale; LEI, Leeds Enthesitis Index; ASAS, Assessment of SpondyloArthritis International Society; PASI, Psoriasis Area and Severity Index; MDA, Minimal Disease Activity; HAQ, Health Assessment Questionnaire.</p> <p>Table 3. Ultrasound changes at week 52.</p> <p> <ephtml> <table><thead><tr><td>Ultrasound variables</td><td>SEC (<italic>n</italic> = 34)</td><td>ADA (<italic>n</italic> = 21)</td><td>β (95% CI)</td><td><italic>P</italic>-value</td></tr></thead><tbody valign="top"><tr><td><bold>Inflammatory changes</bold></td><td /><td /><td /><td /></tr><tr><td> Change of enthesitis count</td><td char=".">0.03 (1.18)</td><td char=".">−0.05 (2.28)</td><td char=".">−0.66 (-1.56, 0.24)</td><td char=".">0.15</td></tr><tr><td> Change of synovitis count</td><td char=".">−0.79 (1.59)</td><td char=".">−2.43 (2.65)</td><td char=".">0.94 (0.09, 1.79)</td><td char=".">0.03</td></tr><tr><td> Change of synovitis average thickness, mm</td><td char=".">−0.76 (2.81)</td><td char=".">−3.04 (3.17)</td><td char=".">1.05 (-0.28, 2.38)</td><td char=".">0.12</td></tr><tr><td> Change of synovitis average PD signal</td><td char=".">−0.28 (0.57)</td><td char=".">−0.63 (0.68)</td><td char=".">0.20 (0.03, 0.36)</td><td char=".">0.02</td></tr><tr><td> Change of tenosynovitis count</td><td char=".">−0.50 (1.06)</td><td char=".">−0.57 (1.09)</td><td char=".">−0.22 (-0.77, 0.32)</td><td char=".">0.41</td></tr><tr><td> Change of bursitis count</td><td char=".">−0.12 (0.40)</td><td char=".">−0.29 (0.82)</td><td char=".">0.20 (-0.19, 0.59)</td><td char=".">0.32</td></tr><tr><td><bold>Structural changes</bold></td><td /><td /><td /><td /></tr><tr><td> Change of enthesophyte count</td><td char=".">0.76 (1.09)</td><td char=".">0.86 (1.21)</td><td char=".">0.04 (-0.66, 0.75)</td><td char=".">0.90</td></tr><tr><td> Change of bone erosion count</td><td char=".">0.00 (0.54)</td><td char=".">0.14 (0.83)</td><td char=".">−0.13 (-0.56, 0.30)</td><td char=".">0.55</td></tr></tbody></table> </ephtml> </p> <p>3 Data are presented as mean (SD). SEC, secukinumab; ADA, adalimumab; PD, power Doppler.</p> <hd id="AN0181738219-13">Ultrasound outcomes</hd> <p>Given the relatively high cost and complexity of musculoskeletal ultrasound examinations, comprehensive scans of joints, entheses, and tendons were performed only at baseline and week 52. Of the enrolled patients, 56 completed the ultrasound examinations, with 34 in the SEC group and 21 in the ADA group. The primary inflammatory changes in PsA patients, including enthesitis, synovitis, tenosynovitis, and bursitis, were meticulously assessed. At baseline, the ADA group exhibited a higher incidence of these inflammatory changes than the SEC group, with the differences in enthesitis and synovitis counts reaching statistical significance (Table S4). Furthermore, we calculated the average thickness and PD signals of the involved synovium, revealing higher values in the ADA group than in the SEC group (Table S4). Concerning structural changes, the counts of enthesophyte and bone erosion did not show significant differences between the two groups at baseline (Table S4).</p> <p>At week 52, the same variables were reevaluated for these patients. Changes in these variables from baseline to week 52 were calculated to compare the difference between the SEC and ADA groups. To eliminate the effects of confounding factors, we included baseline variables with statistical significance (enthesitis count, synovitis count, synovitis average thickness, and synovitis average PD signal) in multiple linear regression models as covariates. The results showed that inflammatory changes could be restored by both biologics, while bone erosion and enthesophyte appeared to be irreversible (Table 3). Of these inflammatory changes, adalimumab exhibited superior improvement for synovitis count (β: 0.94, 95%CI: 0.09–1.79, <emph>p</emph> = 0.03, Table 3) and synovitis PD signal (β: 0.20, 95%CI: 0.03–0.36, <emph>p</emph> = 0.02, Table 3) compared to secukinumab.</p> <hd id="AN0181738219-14">Discussion</hd> <p>In this prospective real-world study, both adalimumab and secukinumab exhibited comparable clinical efficacy in treating PsA across multiple musculoskeletal domains, including peripheral arthritis, enthesitis, and axial arthritis. Notably, our analysis pinpointed distinct advantages for each medication in managing PsA. Adalimumab demonstrated superior capability in ameliorating inflammatory joint changes, as evidenced by thorough ultrasonographic evaluations, while secukinumab showed significantly greater skin improvement over adalimumab.</p> <p>Regarding peripheral joint improvement in PsA, there was no substantial difference in clinical evaluation between adalimumab and secukinumab. This finding aligns with previous research, including a head-to-head trial comparing TNFi and IL-17i, which have reported similar response rates in terms of the primary endpoints like ACR20, as well as secondary endpoints like ACR50, ACR70, and PsARC ([<reflink idref="bib7" id="ref26">7</reflink>]). Simultaneously, our study further corroborates the nearly equivalent impact of these biologics on the clinical responsiveness of axial arthritis, an area without direct comparisons due to a scarcity of head-to-head RCTs or real-world studies. However, when focusing on the reduction of pain—evaluated <emph>via</emph> VAS—for both peripheral and axial involvement, adalimumab demonstrated a more favorable pain-relieving trend over secukinumab. This distinction in pain amelioration is a relevant consideration for therapeutic decision-making, particularly for PsA patients for whom pain management is a significant concern.</p> <p>To our knowledge, this study is the first to comprehensively compare the effects of adalimumab and secukinumab on inhibiting radiographic progression in PsA patients. Ultrasound examinations were employed to assess the inflammatory and structural changes in PsA patients due to its convenience, high sensitivity, and absence of radiation exposure ([<reflink idref="bib21" id="ref27">21</reflink>], [<reflink idref="bib22" id="ref28">22</reflink>]). Among typical ultrasound-detected inflammatory changes, enthesitis is a key hallmark of PsA ([<reflink idref="bib23" id="ref29">23</reflink>]), and our data indicated that the counts of ultrasound-confirmed enthesitis decreased following treatment of both adalimumab and secukinumab, with similar reduction rates. Likewise, an earlier open-label study indicated that the MASEI score, another measurement for enthesitis, also showed no significant difference between adalimumab and secukinumab ([<reflink idref="bib24" id="ref30">24</reflink>]). This pattern was mirrored in the changes observed for tenosynovitis and bursitis. However, while the effectiveness of adalimumab and secukinumab in reducing synovitis has been evaluated and confirmed individually in previous research ([<reflink idref="bib25" id="ref31">25</reflink>], [<reflink idref="bib26" id="ref32">26</reflink>]), no comparative data existed between these two biologics. As an extension of previous observations, our findings demonstrated that adalimumab provided a more favorable response in terms of reducing the counts of synovitis and PD signals than secukinumab. The difference between ultrasonography and clinical evaluation may be due to the different aspects they assess and their varying sensitivities. Ultrasound can detect synovial thickness, blood flow signals, and underlying synovitis, whereas clinical evaluation focuses on visible symptoms, highlighting the potential of ultrasonography as a valuable tool for monitoring treatment efficacy in PsA. Ultimately, we determined that neither adalimumab nor secukinumab could reverse structural abnormalities such as enthesophytes and bone erosions. This finding aligns with numerous previous reports indicating that biologics as well as methotrexate, do not significantly reduce the Sharp scores in PsA patients ([<reflink idref="bib27" id="ref33">27</reflink>]). However, the prospective IVEPSA study ([<reflink idref="bib28" id="ref34">28</reflink>]), which enrolled psoriasis patients with subclinical joint inflammation, suggested that erosions and enthesophytes did not progress following treatment with an IL-17A inhibitor. This implies that very early intervention in PsA may be possible, potentially leading to better outcomes in terms of structural changes in PsA patients.</p> <p>It is essential to manage both joint and skin for patients with PsA, as both could severely affect patients' quality of life. Our findings indicated that secukinumab has a significantly superior skin efficacy versus adalimumab. Similarly, head-to-head RCTs and real-world studies comparing IL-17i, such as secukinumab or ixekizumab, with adalimumab, have also demonstrated the superiority of IL-17i in achieving skin-related and skin-joint combined endpoints ([[<reflink idref="bib29" id="ref35">29</reflink>], [<reflink idref="bib31" id="ref36">31</reflink>]]).</p> <p>This prospective real-world cohort study features the advantages of naturalistic therapeutic selection and follow-up processes, which could reflect real-life conditions. Remarkably, our observations highlight the critical role of ultrasound in guiding therapeutic choices and monitoring the disease activity of PsA during treatment. The combination of clinical assessments and ultrasound evaluations has yielded evidence regarding the superiority or non-inferiority efficacy of adalimumab and secukinumab across multiple parameters, which could assist in decision-making between these two first-line biologics for PsA. This study has some limitations due to its non-randomized design, which could lead to selection bias and potential confounders. In the future, there is still a need for larger-scale, long-term comparative real-world studies between secukinumab and adalimumab that incorporate ultrasound evaluation to further investigate the implications of ultrasound results.</p> <p>In conclusion, this prospective real-world study has provided valuable insights for the selection of secukinumab or adalimumab in treating PsA. Secukinumab should be recommended as the preferred choice for patients with more severe skin involvement, whereas adalimumab could be better suited for patients experiencing more pronounced joint or back pain. Additionally, based on detailed ultrasound examinations, both secukinumab and adalimumab are appropriate for PsA patients with axial involvement and/or peripheral arthritis, primarily exhibiting enthesitis, tenosynovitis, and bursitis. In case of ultrasound-confirmed significant synovitis, adalimumab might be the favored option.</p> <hd id="AN0181738219-15">Acknowledgements</hd> <p>We thank for the ultrasound examinations provided by Dr. Yuanjiao Tang, Dr. Ling Zhong and Dr. Lingyan Zhang who are from the Department of Ultrasound in West China Hospital of Sichuan University.</p> <hd id="AN0181738219-16">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0181738219-17">Ethical approval</hd> <p>Ethical approval for this study was granted by the West China Hospital's ethics committee, affiliated with Sichuan University (approval number: 2020(<reflink idref="bib321" id="ref37">321</reflink>)), and it was duly registered with the Chinese Clinical Trial Registry (approval number: ChiCTR2300073642). 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Dermatol Ther (Heidelb). 2022; 12 (9): 2105 – 2115. doi: 10.1007/s13555-022-00787-x.</bibtext> </blist> </ref> <aug> <p>By Yiyi Wang; Yue Xiao; Lingyan Zhang; Furong Li; Hongxiang Hu; Xiya Peng; Jingya Gao; Min Yang; Wei Yan; Li Qiu and Wei Li</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib10" firstref="ref12"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref13"></nolink> <nolink nlid="nl3" bibid="bib321" firstref="ref14"></nolink> <nolink nlid="nl4" bibid="bib12" firstref="ref15"></nolink> <nolink nlid="nl5" bibid="bib13" firstref="ref16"></nolink> <nolink nlid="nl6" bibid="bib14" firstref="ref18"></nolink> <nolink nlid="nl7" bibid="bib16" firstref="ref19"></nolink> <nolink nlid="nl8" bibid="bib18" firstref="ref20"></nolink> <nolink nlid="nl9" bibid="bib19" firstref="ref21"></nolink> <nolink nlid="nl10" bibid="bib20" firstref="ref23"></nolink> <nolink nlid="nl11" bibid="bib21" firstref="ref27"></nolink> <nolink nlid="nl12" bibid="bib22" firstref="ref28"></nolink> <nolink nlid="nl13" bibid="bib23" firstref="ref29"></nolink> <nolink nlid="nl14" bibid="bib24" firstref="ref30"></nolink> <nolink nlid="nl15" bibid="bib25" firstref="ref31"></nolink> <nolink nlid="nl16" bibid="bib26" firstref="ref32"></nolink> <nolink nlid="nl17" bibid="bib27" firstref="ref33"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref34"></nolink> <nolink nlid="nl19" bibid="bib29" firstref="ref35"></nolink> <nolink nlid="nl20" bibid="bib31" firstref="ref36"></nolink>
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  Data: Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments
– Name: Author
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  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Yiyi+Wang%22">Yiyi Wang</searchLink><br /><searchLink fieldCode="AR" term="%22Yue+Xiao%22">Yue Xiao</searchLink><br /><searchLink fieldCode="AR" term="%22Lingyan+Zhang%22">Lingyan Zhang</searchLink><br /><searchLink fieldCode="AR" term="%22Furong+Li%22">Furong Li</searchLink><br /><searchLink fieldCode="AR" term="%22Hongxiang+Hu%22">Hongxiang Hu</searchLink><br /><searchLink fieldCode="AR" term="%22Xiya+Peng%22">Xiya Peng</searchLink><br /><searchLink fieldCode="AR" term="%22Jingya+Gao%22">Jingya Gao</searchLink><br /><searchLink fieldCode="AR" term="%22Min+Yang%22">Min Yang</searchLink><br /><searchLink fieldCode="AR" term="%22Wei+Yan%22">Wei Yan</searchLink><br /><searchLink fieldCode="AR" term="%22Li+Qiu%22">Li Qiu</searchLink><br /><searchLink fieldCode="AR" term="%22Wei+Li%22">Wei Li</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: Journal of Dermatological Treatment, Vol 35, Iss 1 (2024)
– Name: Publisher
  Label: Publisher Information
  Group: PubInfo
  Data: Taylor & Francis Group, 2024.
– Name: DatePubCY
  Label: Publication Year
  Group: Date
  Data: 2024
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  Label: Collection
  Group: HoldingsInfo
  Data: LCC:Dermatology
– Name: Subject
  Label: Subject Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Psoriatic+arthritis%22">Psoriatic arthritis</searchLink><br /><searchLink fieldCode="DE" term="%22secukinumab%22">secukinumab</searchLink><br /><searchLink fieldCode="DE" term="%22adalimumab%22">adalimumab</searchLink><br /><searchLink fieldCode="DE" term="%22clinical+efficacy%22">clinical efficacy</searchLink><br /><searchLink fieldCode="DE" term="%22ultrasound+evaluation%22">ultrasound evaluation</searchLink><br /><searchLink fieldCode="DE" term="%22Dermatology%22">Dermatology</searchLink><br /><searchLink fieldCode="DE" term="%22RL1-803%22">RL1-803</searchLink>
– Name: Abstract
  Label: Description
  Group: Ab
  Data: Background and objectives: Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disorder affecting 30% of psoriatic patients. Effective treatment, especially with biologics like IL-17 and TNF inhibitors, is vital for improving patient outcomes. This study aimed to compare the efficacy of secukinumab and adalimumab in PsA patients through clinical and ultrasonographic evaluations.Materials and methods: We enrolled 116 PsA patients, with 58 patients receiving secukinumab and 58 receiving adalimumab. Regular follow-ups were conducted at weeks 4, 12, 24, and 52. The primary outcome was the proportion of patients achieving at least a 20% improvement in the ACR response (ACR20) at week 12, with additional evaluations for axial arthritis, enthesitis, skin involvement, minimal disease activity, health assessment questionnaire, and ultrasound changes.Results: There was no significant difference in ACR20 response between the two groups at week 12 (OR: 0.59, 95% CI: 0.26–1.37, p = 0.22). However, secukinumab demonstrated superior efficacy in achieving Psoriasis Area and Severity Index (PASI)90 (OR: 2.25, 95%CI: 1.07–4.74, p = 0.03), while adalimumab showed better improvement in ultrasound synovitis count (β: 0.94, 95%CI: 0.09–1.79, p = 0.03) and synovitis PD signal (β: 0.20, 95%CI: 0.03–0.36, p = 0.02).Conclusions: In conclusion, both treatments were highly effective for PsA, with secukinumab being more suitable for severe skin involvement and adalimumab for significant ultrasound-confirmed synovitis.
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  Data: article
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  Data: electronic resource
– Name: Language
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  Data: English
– Name: ISSN
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  Data: 09546634<br />1471-1753<br />0954-6634
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  Data: https://doaj.org/toc/0954-6634; https://doaj.org/toc/1471-1753
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  Label: DOI
  Group: ID
  Data: 10.1080/09546634.2024.2411849
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  Data: edsdoj.bce3f39406de4523b9cb5314736aee95
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        Value: 10.1080/09546634.2024.2411849
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      – Text: English
    Subjects:
      – SubjectFull: Psoriatic arthritis
        Type: general
      – SubjectFull: secukinumab
        Type: general
      – SubjectFull: adalimumab
        Type: general
      – SubjectFull: clinical efficacy
        Type: general
      – SubjectFull: ultrasound evaluation
        Type: general
      – SubjectFull: Dermatology
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      – SubjectFull: RL1-803
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      – TitleFull: Superior effect of adalimumab versus secukinumab on ultrasound-confirmed synovitis in psoriatic arthritis: comprehensive evidence from musculoskeletal ultrasound and clinical assessments
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              M: 12
              Type: published
              Y: 2024
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