Comparative efficacy and safety of biologics in moderate to severe plaque psoriasis: a multiple‐treatments meta‐analysis

Abstract

Objective: To compare the efficacy and safety of biologics for patients with moderate to severe plaque psoriasis. Methods: We systematically reviewed 60 randomized controlled trials (34,020 participants), which compared 14 biological drugs for treatment of moderate to severe plaque psoriasis. The main assessment criteria were ≥ 90 % reductions in Psoriasis Area and Severity Index (PASI 90) and the number of patients who reported treatment-emergent adverse events (AEs). Secondary criteria were ≥ 75 % reductions in Psoriasis Area and Severity Index (PASI 75), Physician's Global Assessment 0/1 (PGA 0/1) and infections. Results: This network meta-analysis showed that biologics were significantly more effective than placebo. Ixekizumab, risankizumab, and bimekizumab were among the most effective treatments, and tildrakizumab, guselkumab and risankizumab were better than the other drugs with respect to safety. Risankizumab and guselkumab performed relatively stable with respect to both efficacy and safety. At the class level, blockers of interleukin (IL)-17A showed favorable efficacy while inhibitors of the p19 subunit of IL-23 were best tolerated of all efficient biologics. Conclusions: Ixekizumab was the most effective biologic in PASI 90, while IL-23p19 inhibitors, risankizumab and guselkumab performed relatively stable with respect to efficacy and safety.

Newer Biologics for the Treatment of Plaque Psoriasis

“…The search strategies were comprehensive, with multiple electronic databases (e.g., Embase, MEDLINE, Cochrane Central Register of Controlled Trials) searched in all systematic reviews. [18][19][20][21][22][23][24][25] Other sources such as bibliographies, trial registries, and conference proceedings were searched in 2 reviews. 19,20 Two systematic reviews searched for studies published until 2020 20,21 and 3 systematic reviews searched for studies published until 2019.…”

“…19,20 Two systematic reviews searched for studies published until 2020 20,21 and 3 systematic reviews searched for studies published until 2019. 18,22,24 In 2 systematic reviews, studies published until 2018 25 and 2017 23 were captured. The search date was unclear in 1 systematic review.…”

“…These comprised 8 systematic reviews with network meta-analyses. [18][19][20][21][22][23][24][25] Appendix 1 presents the PRISMA 26 flow chart of the study selection.…”

“…Eight systematic reviews with NMA were included in this report. [18][19][20][21][22][23][24][25] Four of them were published in 2021 [18][19][20][21] and 4 in 2020. [22][23][24][25] One of the included reviews was a Cochrane living systematic review, 20 which means that the authors will continually update the review as new evidence becomes available.…”

“…Lastly, 4 systematic reviews 19,[21][22][23] were sponsored by pharmaceutical companies and 3 systematic reviews 18,20,24 were funded by institutional grants. One review 25 was conducted on behalf of the British Association of Dermatologists as an evidence base to produce treatment guidelines.…”