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Secukinumab vs Adalimumab in AS: Controversial Trial Design

June 10 2016 8:09 PM ET via RheumReports RheumReports

There was an interesting abstract session today on expanding therapeutic options in spondyloarthritis. When I glanced at the titles of the secukinumab abstracts, I assumed it would be a head to head comparison against adalimumab for the treatment of AS. I was wrong. Instead there were two abstracts using a trial design called matching-adjusted indirect comparison (MAIC). Being a simple clinical rheumatologist, I am the last one who should be reporting on statistics or epidemiology as it was quite difficult to follow! Nevertheless, I will give you the bottom line as I saw it. 

First, Dr Maksymowych presented his study of Secukinumab for the Treatment of AS: Comparative Effectiveness Results vs Adalimumab Using a Matching-adjusted Indirect Comparison. He did a very good job of explaining this particular trial design. It compared two trials, Measure 1 and Atlas, and used MAIC to match the patients' baseline characteristics as well as correcting for differences in trial design, thus enabling a simulation of a head to head comparison. 

The second was a very similar study from the US comparing the relative effectiveness of adalimumab vs secukinumab using MAIC . The first study essentially showed a numerical difference in ASAS 20 and 40 in favour of secukinumab that was statistically significant, whereas the second trial showed essentially similar efficacy. 

It was the discussion after the abstracts that was most entertaining. Two leading European SpA experts took great issue with this particular trial design, which they felt to be not reliable and influenced by industry bias. They concluded that it should be thrown out in favour of head to head trials . 

The bio statisticians attempted to counter-argue that although there are limitations, this type of study can be hypothesis-generating and give some relative insights when head to head comparisons are not available and is accepted by payers as valid. 

It was the most controversial discussion I have seen at a meeting in a long time. We can keep hoping for a head to head trial but for now this is the best we've got.

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About the Author

Dr. Shelly Dunne
Dr. Shelly Dunne

Dr. Shelley Dunne is a graduate of Memorial University of Newfoundland School of Medicine. She completed her training in Internal Medicine and a fellowship in Rheumatology at the University of Toronto. She has been in private practice since 1998 and is currently a consulting rheumatologist at the Toronto East General Hospital.

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