PMID- 37568031
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231202
IS  - 2198-6576 (Print)
IS  - 2198-6584 (Electronic)
IS  - 2198-6576 (Linking)
VI  - 10
IP  - 5
DP  - 2023 Oct
TI  - Clinical and Economic Benefit of Advanced Therapies for the Treatment of Active 
      Ankylosing Spondylitis.
PG  - 1385-1398
LID - 10.1007/s40744-023-00586-6 [doi]
AB  - INTRODUCTION: Recent changes to treatment guidelines for ankylosing spondylitis 
      (AS) have listed first-line advanced therapies as tumor necrosis factor (TNF), 
      interleukin (IL)-17, and Janus kinase (JAK) inhibitors. This study sought to 
      assess the comparative clinical and economic benefit of advanced therapies 
      approved for AS. METHODS: A systematic literature review was conducted to 
      identify randomized clinical trials for JAK inhibitors (upadacitinib [UPA], 
      tofacitinib [TOF]), anti-IL-17 therapies (secukinumab [SEC], ixekizumab [IXE]), 
      and TNF inhibitors (adalimumab [ADA], etanercept [ETN], golimumab [GOL]) used for 
      the treatment of active AS. Clinical efficacy was evaluated by Assessment of 
      Spondyloarthritis International Society 40 (ASAS40) criteria and treatment 
      discontinuation due to adverse events (AEs) was used to generate response rates 
      synthesized via a Bayesian network meta-analysis. Number needed to treat (NNT) 
      was calculated as the reciprocal of incremental response rate of each treatment 
      versus placebo. Cost per ASAS40 responder (CPR) was calculated as the 12-week 
      treatment costs divided by ASAS40 response rates. Data were stratified by 
      biologic treatment status (i.e., biologic naive [bio-naive] or inadequate 
      response or intolerance to biologics [bio-IR]) for efficacy and CPR analyses. 
      RESULTS: Among bio-naive patients, the response rate for ASAS40 was 53.6% for 
      UPA-treated patients, whereas most other treatments had response rates between 
      41% and 49%. NNTs were lowest for UPA-treated patients at 2.8 (other therapies 
      3.2-4.8). Estimated CPR among UPA-treated patients was lowest (UPA $39.5k vs 
      others $44.2k-102.5k). Efficacy and CPR trends were similar among bio-IR and 
      TNF-IR patients. Among bio-naive and bio-IR patients, the rate of AEs leading to 
      discontinuation was lowest among UPA and SEC-treated patients (0.0, others 
      0.6-3.7%). CONCLUSIONS: Relative to other treatments assessed in this study, UPA 
      demonstrated numerically greater clinical and economic benefit for the treatment 
      of AS. Head-to-head or real-world comparisons of these therapies are warranted 
      and may inform clinical decision-making.
CI  - (c) 2023. The Author(s).
FAU - Walsh, Jessica A
AU  - Walsh JA
AD  - Division of Rheumatology, Clinic 2, Salt Lake City Veterans Affairs and 
      University of Utah, 50 North Medical Drive, Salt Lake City, UT, 84132, USA. 
      Jessica.Walsh@hsc.utah.edu.
FAU - Saffore, Christopher D
AU  - Saffore CD
AD  - AbbVie Inc., North Chicago, IL, USA.
FAU - Collins, Eric B
AU  - Collins EB
AD  - Medicus Economics LLC, Boston, MA, USA.
FAU - Ostor, Andrew
AU  - Ostor A
AD  - Cabrini Medical Center, Monash University, Melbourne, Australia.
AD  - Australian National University, Canberra, Australia.
LA  - eng
PT  - Journal Article
DEP - 20230812
PL  - England
TA  - Rheumatol Ther
JT  - Rheumatology and therapy
JID - 101674543
EIN - Rheumatol Ther. 2024 Feb;11(1):225-226. PMID: 38019452
PMC - PMC10468449
OTO - NOTNLM
OT  - Ankylosing spondylitis
OT  - Network meta-analysis
OT  - Treatment effectiveness
OT  - Upadacitinib
COIS- Andrew Ostor has received consultant fees, acted on advisory boards, and 
      participated in clinical trials for AbbVie, Janssen, Lilly, Novartis, Pfizer & 
      GSK. Jessica A. Walsh has nothing to disclose. Christopher D Saffore is an 
      employee of AbbVie Inc. and may hold stock. Eric B Collins is an employee of 
      Medicus Economics LLC, which received consulting fees and research support from 
      AbbVie.
EDAT- 2023/08/12 10:41
MHDA- 2023/08/12 10:42
PMCR- 2023/08/12
CRDT- 2023/08/11 23:27
PHST- 2023/05/24 00:00 [received]
PHST- 2023/07/13 00:00 [accepted]
PHST- 2023/08/12 10:42 [medline]
PHST- 2023/08/12 10:41 [pubmed]
PHST- 2023/08/11 23:27 [entrez]
PHST- 2023/08/12 00:00 [pmc-release]
AID - 10.1007/s40744-023-00586-6 [pii]
AID - 586 [pii]
AID - 10.1007/s40744-023-00586-6 [doi]
PST - ppublish
SO  - Rheumatol Ther. 2023 Oct;10(5):1385-1398. doi: 10.1007/s40744-023-00586-6. Epub 
      2023 Aug 12.