Adalimumab in PsA: A meta-analysis

Results from a systematic review and meta-analysis evaluating the efficacy and safety of adalimumab across 17 randomized controlled trials, including 5,655 patients with psoriatic arthritis (PsA), were published in Medicine by Cai et al. Efficacy outcomes included American College of Rheumatology 20% improvement in response (ACR20), ACR50, ACR70, ≥75% improvement from baseline in Psoriasis Area and Severity Index (PASI75), PASI90, and PASI100 response rates. 

Key data: Adalimumab vs placebo demonstrated improvements in ACR20 (risk ratio [RR], 2.27; 95% confidence interval [CI], 1.83–2.83), ACR50 (RR, 3.92; 95% CI, 2.98–5.15), and ACR70 (RR, 5.75; 95% CI, 4.47–7.39). Similarly, PASI75 (7.07; 95% CI, 4.36–11.46), PASI90 (4.27; 95% CI, 1.64–11.14), and PASI100 (8.23; 95% CI, 3.89–17.40) were improved with adalimumab vs placebo. No significant increases in overall adverse events (AEs) or serious AEs (SAEs) were observed. Adalimumab was associated with elevated risk of opportunistic infections (RR, 6.00), raised alanine aminotransferase (ALT; RR, 4.09), raised aspartate aminotransferase (AST; RR, 5.41), neutropenia (RR, 3.62), depression (RR, 3.07), injection site reactions (RR, 1.92), serious infections (RR, 1.69), urinary tract infections (UTIs; RR, 1.45), back pain (RR, 1.32), nausea (RR, 1.23), and death (RR, 1.01). 

Key learning: In a meta-analysis of 17 studies, adalimumab demonstrated clinically meaningful efficacy across joint and skin outcomes in PsA, although a potential signal for elevated liver enzymes was observed. Liver function monitoring may therefore be warranted during treatment.