Comparative effectiveness and predictors of remission between adalimumab and ixekizumab in patients with psoriatic arthritis: findings from the 'AIRE' multicentre study

BACKGROUND: Tumour necrosis factor α (TNFi) and interleukin 17 (IL-17) inhibitors have demonstrated efficacy and safety in psoriatic arthritis (PsA) therapy through head-to-head randomised controlled trials, but evidence from real-world clinical practice (RWE) remains limited. METHODS: Adalimumab vs Ixekizumab Real-world Effectiveness is a multicentre cohort study, aimed at comparing the effectiveness of these drugs in a 'real-world' PsA population. The primary outcome consisted of mixed-effects models comparing Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriasis Areas and Severity Index (PASI) over 12 months in both treatment groups. Remission outcomes (DAPSA; Minimal Disease Activity (MDA)) were analysed using time-dependent Cox models adjusted for confounders. RESULTS: A total of 437 patients (42% on adalimumab (ADA); 57% on ixekizumab (IXE)) were enrolled. At baseline, the ADA group mainly showed axial and nail involvement, while the IXE group was mostly biologic disease-modifying antirheumatic drug (bDMARD)-experienced and had higher C reactive protein levels and worse functional status.The DAPSA score improved in both groups, and between-treatment differences in DAPSA pathways over time were not significant. Probabilities of achieving DAPSA remission or MDA did not differ by drug at 12 months. PASI improved similarly in both groups, but IXE showed a greater early reduction from baseline at 3 months. DAPSA remission and MDA were primarily associated with male sex, absence of nail psoriasis, higher PASI, fewer prior bDMARDs and better functional status. CONCLUSIONS: This RWE study showed that ADA and IXE provide similar 12-month joint outcomes, while IXE showed a faster skin response. Baseline demographic and clinical features affect the chance of remission, highlighting the importance of personalised treat-to-target approaches in PsA.