Objective: This study aimed to determine the relative effectiveness and safety of secukinumab, ixekizumab, and tofacitinib in patients with psoriatic arthritis (PsA) showing insufficient responses to tumor necrosis factor (TNF) inhibitors.
Materials and methods: A Bayesian network meta-analysis was conducted using direct and indirect data from five randomized controlled trials that examined the efficacy and safety of secukinumab 150 mg or 300 mg every 4 weeks, subcutaneously injected ixekizumab 80 mg every 2 weeks (Q2W) or every 4 weeks (Q4W), and tofacitinib 5 mg or 10 mg twice orally in active PsA patients responding insufficiently to TNF inhibitors.
Results: Six RCTs, including 1,279 patients, fulfilled the inclusion criteria. Secukinumab 300 mg, listed at the top left of the league table diagonal, was associated with the most favorable American College of Rheumatology 20 (ACR20) response rate. Contrastingly, the placebo, listed at the bottom right of the league table diagonal, showed the least favorable results. The ixekizumab 80 mg Q2W or Q4W, secukinumab 150 mg, and tofacitinib 5 or 10 mg groups exhibited significantly higher ACR20 responses than the placebo group. The surface under the cumulative ranking curve (SUCRA)-based ranking probability suggested that secukinumab 300 mg was most likely the best treatment to achieve the ACR20 response rate, followed by ixekizumab 80 mg Q2W, secukinumab 150 mg, ixekizumab 80 mg Q4W, tofacitinib 5 and 10 mg, and the placebo.
Conclusion: Secukinumab, ixekizumab, and tofacitinib were effective in PsA patients with inadequate response to TNF inhibitors, without serious adverse event risks.