Long-term efficacy of netakimab in the treatment of radiographic axial spondyloarthritis: Results of a systematic review and simulated indirect comparisons

The aim – to compare the long-term efficacy of netakimab with other registered drugs in the Russian Federation to treat radiographic axial spondyloarthritis over a period of up to 3 years. Materials and methods . A systematic literature search was conducted in PubMed and Embase databases. 19 publications evaluating the results of 11 clinical trials were selected. The simulated treatment comparison method according to NICE DSU TSD 18 (National Institute for Health and Care Excellence Decision Support Unit Technical Support Document 18) recommendations was used for comparison. Age, sex, BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), ASDAS (Ankylosing Spondylitis Disease Activity Score), C-reactive protein, disease duration since axial spondyloarthritis diagnosis, and HLA-B27 status were selected as confounding variables for adjustment. Results . Netakimab demonstrated superiority over all interleukin 17 and tumor necrosis factor α (TNF-α) inhibitors, as well as tofacitinib, on the main efficacy endpoints ASAS20 and ASAS40 (20% and 40% improvement according to the Assessment of SpondyloArthritis international Society criteria) over a period of up to 3 years. No superiority was detected compared to upadacitinib. Conclusion. Netakimab is one of the most superior therapeutic option among available biologics for long-term treatment of active axial spondyloarthritis. Using netakimab as the first-line or second-line therapy allows achieving treatment goals with the highest probability. The results are useful for evidence-based clinical decision-making when choosing biological therapy considering patient profile and can be used for planning treatment strategy after TNF-α inhibitor failure.