A Systematic Review With Network Meta-Analysis of the Available Biologic Therapies for Psoriatic Disease Domains

Abstract

Introduction: Several new treatments have been developed for psoriatic disease, an inflammatory condition that involves skin and joints. Notwithstanding, few studies have made direct comparisons between treatments and therefore it is difficult to select the ideal treatment for an individual patient. The aim of this systematic review with network meta-analysis (NMA) was to analyze available and approved biologic therapies for each domain of psoriatic disease: skin, peripheral arthritis, axial arthritis, enthesitis, dactylitis, and nail involvement.Methods: Data from randomized clinical trials (RCTs) were included. A systematic review was performed using the MEDLINE database (July 2020) using PICO criteria. Bayesian NMA was conducted to compare the clinical efficacy of biological therapy in terms of the American College of Rheumatology criteria (ACR, 24 weeks) and Psoriasis Area and Severity Index (PASI, 10–16 weeks).Results: Fifty-four RCTs were included in the systematic review. Due to the design of the RCTs, namely, outcomes and time points, network meta-analysis was performed for skin and peripheral arthritis domains. For the skin domain, 30 studies reporting PASI100 were included. The peripheral arthritis domain was analyzed through ACR70 in 12 studies. From the therapies approved for both domains, secukinumab and ixekizumab were the ones with the highest probability of reaching the proposed outcomes. There is a lack of outcome uniformization in the dactylitis, enthesitis, and nail domains, and therefore, an objective comparison of the studies was not feasible. Nevertheless, secukinumab was the treatment with the best compromise between the number of studies in each domain and the results obtained in the different outcomes.Conclusion: Secukinumab and ixekizumab were the treatments with the highest probability of reaching both PASI100 and ACR70 outcomes. Due to the lack of a standard evaluation of outcomes of the other psoriatic disease domains, a network meta-analysis for all the domains was not possible to perform.

Uptake and effectiveness of newer biologic and targeted synthetic disease-modifying antirheumatic drugs in psoriatic arthritis: results from five Nordic biologics registries

“…Further, all types of disease domains are not covered in the outcome measures—for example, skin manifestations, dactylitis and enthesitis are not sufficiently captured in the rheumatology registries contributing to this study, and while 28-joint counts are available the data on 66/68-joint counts had high missingness and data on axial involvement were not available. This could impact our study results as the available b/tsDMARDs affect the PsA domains differently 38. Other comorbidities that are primarily treated in primary care, such as depression and fibromyalgia, are also not adequately captured through the national registers and may be prevalent in difficult-to-treat patients.…”

Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 2 trial

“…8 9 Although biological agents are effective in treating PsA, 10 approximately 25%-40% of patients do not achieve at least 20% improvement in American College of Rheumatology score (ACR20), and clinical REM and minimal disease activity (MDA) are often short-lived. [11][12][13][14][15][16][17][18][19] Lack of efficacy frequently leads to treatment switching or discontinuation, which may negatively affect patients' clinical outcomes and increase treatment costs, [20][21][22][23][24] revealing a need for well-tolerated treatments with sustained efficacy.…”

Clinical Characteristics of Registry Participants with Psoriatic Arthritis Initiating Guselkumab: An Analysis from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry

“…It is sometimes also associated with related conditions such as inflammatory bowel disease (IBD) and uveitis [2,3]. The clinical manifestations of PsA can include peripheral arthritis, axial disease, skin and nail disease, dactylitis, and enthesitis [2][3][4][5]. The presence and severity of clinical manifestations vary widely by patient, from mild joint inflammation to severe debilitating joint damage with skin and nail involvement [6].…”