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Secukinumab in the Treatment of Moderate to Severe Plaque Psoriasis Based on the ECLIPSE Trial

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Secukinumab in the Treatment of Moderate to Severe Plaque Psoriasis Based on the ECLIPSE Trial Cost per responder analysis of guselkumab versus secukinumab in the treatment of moderate to severe plaque psoriasis based on the ECLIPSE trial Cheryl Druchok1, Alicia N. Pepper1, Jamie Garside2, Fareen Hassan3 1Cornerstone Research Group, Burlington, ON, Canada, 2Janssen UK, High Wycombe, England, 3Janssen EMEA, High Wycombe, England INTRODUCTION RESULTS • Several biologic therapies are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment • At week 48, guselkumab had a lower cost per PASI 90 responder than secukinumab (Figure 3), a result of: of moderate to severe plaque psoriasis, including tumor necrosis factor alpha inhibitors, an interleukin (IL)-12/23 inhibitor, IL-17 Lower overall drugs costs for guselkumab (Table 1). inhibitors, and IL-23 inhibitors.1 o o A significantly greater proportion of patients treated with guselkumab achieving a PASI 90 response (84.5% vs. 70.0%, • Network meta-analyses suggest IL-23 and IL-17 inhibitors are the most efficacious biologic therapies.2 P < 0.001; Table 1 and Figure 1). • In ECLIPSE, the first head-to-head Phase 3 trial to compare an IL-23 inhibitor (guselkumab) and an IL-17 inhibitor • Additionally, at all timepoints assessed from Week 12 to 48, guselkumab had a lower cost per PASI 90 responder than (secukinumab), guselkumab was shown to have superior long-term efficacy compared with secukinumab.3 secukinumab (Figure 4). • Considering the chronic nature of moderate to severe psoriasis, it is important to determine the long-term economic value of • Guselkumab had higher PASI 100 and IGA 0/1 response rates at Week 48 compared with secukinumab (Table 1), leading to these biologic therapies. lower costs per PASI 100 and IGA 0/1 responders at Week 48 (Figure 5). Guselkumab also had lower costs per PASI 100 and IGA 0/1 responders at all timepoints assessed from Week 12 to 48 (data not shown). OBJECTIVE Figure 3: Cost per PASI 90 responder at Week 48 • To estimate the cost per responder in the United Kingdom (UK) of guselkumab and secukinumab, leveraging treatment cost data and head-to-head efficacy results from ECLIPSE. £5,737 cost savings METHODS £25,000 £24,376 • A cost per responder model was developed to compare the cost of guselkumab per treatment response versus the cost of £20,000 £18,639 secukinumab per treatment response. • Efficacy data from the ECLIPSE trial were used to inform treatment response in the model (Table 1 and Figure 1).3 £15,000 Guselkumab Secukinumab • Treatment response definitions included: achievement of 90% improvement in baseline Psoriasis Area and Severity Index (PASI) £10,000 score (i.e., PASI 90 response), PASI 100 response, or an Investigator’s Global Assessment (IGA) score of 0/1 (cleared/minimal). per Responder Cost • The model only considers drug costs, which were based on 2019 UK list prices as published in the British National Formulary £5,000 (Table 1).4 • Dosing regimens were based on the European Medicines Agency Summary of Product Characteristics for guselkumab and £0 secukinumab (Table 1 and Figure 2).5,6 • The primary analyses were conducted for PASI 90 at Week 48, the primary endpoint of the ECLIPSE trial, and every four weeks from Week 12 to Week 48. The earliest timepoint assessed was Week 12 since this is the timepoint at which NICE recommends Figure 4: Cost per PASI 90 responder over time stopping secukinumab treatment in patients who have not responded adequately.7 • Additional analyses were conducted for PASI 100 and IGA 0/1 at Week 48. £30,000 £25,000 Table 1: Cost per responder model inputs £20,000 £15,000 Efficacy at Week 483 Formulation Drug Cost at Dosing Regimen5,6 Formulation £10,000 Cost4 Week 48 PASI 90 PASI 100 IGA 0/1 Cost per Responder Cost £5,000 £0 100 mg SC at Weeks 0, 4, Guselkumab 100 mg £2,250.00 £15,750 84.5% 58.2% 85.0% 12 16 20 24 28 32 36 40 44 48 and 12, then Q8W Week Guselkumab Secukinumab 300 mg SC at Weeks 0, 1, 2, Secukinumab 300 mg £1,218.78 £17,063 70.0% 48.4% 74.9% 3, and 4, then monthly Figure 5: Costs per PASI 100 (A) and IGA 0/1 (B) responders at Week 48 Figure 1: PASI 90 response rates for guselkumab and secukinumab over time in the ECLIPSE trial A £8,192 cost savings B £4,252 cost savings £40,000 £25,000 100% £35,254 £22,781 £35,000 £20,000 £18,529 £30,000 £27,062 80% £25,000 £15,000 60% £20,000 £15,000 £10,000 Cost per Responder Cost 40% £10,000 per Responder Cost % Responders % £5,000 £5,000 20% £0 £0 Guselkumab Secukinumab Guselkumab Secukinumab 0% 0 4 8 12 16 20 24 28 32 36 40 44 48 Week Guselkumab Secukinumab CONCLUSIONS • Based on data from the ECLIPSE trial, guselkumab had a lower cost per PASI 90 responder than secukinumab at all timepoints assessed from Week 12 to Week 48. Figure 2: Treatment dosing regimens used in the model • Guselkumab also had lower costs per PASI 100 and IGA 0/1 responders at Week 48. • Over 48 weeks of treatment, the cost savings associated with using guselkumab instead of secukinumab could range from Guselkumab: 100 mg SC at Weeks 0, 4, and 12, then every 8 weeks £4,252 to £8,192 per responder, depending on the efficacy measure used. • These results suggest that guselkumab offers greater economic value than secukinumab through approximately one year of treatment, which is a more important time frame to consider than the induction period (12-16 weeks), given the chronic nature of psoriasis. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Secukinumab: 300 mg SC at Weeks 0, 1, 2, 3, and 4, then monthly REFERENCES 1. National Institute for Health and Care Excellence. NICE pathways: psoriasis. Systemic biological therapy for psoriasis. Available at: https://pathways.nice.org.uk/pathways/psoriasis#path=view%3A/pathways/psoriasis/systemic-biological-therapy-for-psoriasis.xml&content=view- node%3Anodes-adalimumab 2. Cameron C, Druchok C, Hutton B, McElligott S, Nair S, et al. (2018) Guselkumab for the treatment of moderate-to-severe plaque psoriasis during induction phase: a systematic review and network meta-analysis. Journal of Psoriasis and Psoriatic Arthritis. 4(2):81-92. 3. Reich K, Armstrong A, Langley R, Flavin S, Randazzo B, et al. (2019) Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase Week 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 3, randomised controlled trial. Lancet. 394(10201):831-839. 4. Monthly Index of Medical Specialties (2019) Available at: http://www.mims.co.uk/. 5. EMA (2018) Tremfya (guselkumab) summary of product characteristics. European Medicines Agency. Available at: https://www.ema.europa.eu/en/documents/product- information/tremfya-epar-product-information_en.pdf 6. EMA (2017) Cosentyx (secukinumab) summary of product characteristics. European Medicines Agency. Efficacy Timepoint Available at: https://www.ema.europa.eu/en/documents/product-information/cosentyx-epar-product-information_en.pdf 7. NICE (2015) National Institute for Health and Care Excellence. Secukinumab for treating moderate to severe plaque psoriasis. Technology appraisal guidance [TA350]. Available at: https://www.nice.org.uk/guidance/ta350/chapter/1-Guidance ISPOR Europe 2019 | 2-6 November | Copenhagen, Denmark.
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