Comparative efficacy and safety of thirteen biologic therapies for patients with moderate or severe psoriasis: A network meta-analysis

Xu, Guomei; Xia, Meng; Jiang, Chengyang; Yu, Ying; Guo-mi, Wang; Yuan, Jiaojiao; Duan, Xingwu

doi:10.1016/j.jphs.2018.12.006

Cited by 28 publications

(45 citation statements)

References 77 publications

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“…In our analysis, the rank probabilities of being the best treatment within the NMA were highest for ixekizumab and brodalumab, which are consistent with those published from other NMAs. [64][65][66][67][68] It is important to mention that these results were consistent even in the analysis of PASI 100 as cohorts that achieve PASI 100 had significantly greater health-related quality of life and pruritus improvements than PASI 75 and PASI 90. 69 It should also be noted that the quality of included studies was high and sensitivity analyses on baseline effect modifiers indicated no significant impact of study-level baseline characteristics on the results of the NMA.…”

Section: Discussionmentioning

confidence: 59%

Efficacy of Brodalumab for Moderate to Severe Plaque Psoriasis: A Canadian Network Meta-Analysis

et al. 2020

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Background Several treatments for plaque psoriasis are available, but it remains challenging for physicians to make informed treatment decisions due to a lack of head-to-head trials. Objectives This network meta-analysis (NMA) compares the efficacy of brodalumab to other biologic agents in Canada for moderate-to-severe plaque psoriasis. Methods A systematic literature review of randomized controlled trials (RCTs) published before October 2017 was conducted to populate the NMA. Comparators included etanercept, infliximab, adalimumab, ustekinumab, secukinumab, ixekizumab, guselkumab, and placebo. The primary outcome was the psoriasis area and severity index (PASI) response at the end of induction phase. A random effects Bayesian multinomial likelihood and probit link model analyzed PASI 75, 90, and 100 responses. Inconsistency and heterogeneity were assessed. Sensitivity analyses were conducted to explore potential effect modifiers like baseline PASI score, age, and weight. Results A total of 43 RCTs were included. Brodalumab 210 mg had significantly better PASI response than etanercept, ustekinumab, adalimumab, secukinumab, and guselkumab and comparable responses to infliximab and ixekizumab. Relative risk of PASI 90 response for brodalumab varied from 2.84 (95% credible interval [CrI]: 2.35-3.52, P < .05) to 0.99 (95% CrI: 0.88-1.11, ns) compared to etanercept and ixekizumab. This was similar across PASI 75 responses, but a larger relative risk between brodalumab and all comparators except ixekizumab was observed for PASI 100. No significant heterogeneity or inconsistencies were identified. The results were consistent across sensitivity analyses, indicating robustness of the results. Conclusion Brodalumab 210 mg has efficacy superior to most biologic agents for moderate-to-severe plaque psoriasis in Canada.

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Section: Discussionmentioning

confidence: 59%

Efficacy of Brodalumab for Moderate to Severe Plaque Psoriasis: A Canadian Network Meta-Analysis

et al. 2020

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“…The details of critical appraisal of the NMAs using the ISPOR checklist can be seen in Table 3. Seven analyses were judged to have performed systematic reviews that could have failed to identify and include all relevant RCTs, [18,19,21,22,[24][25][26] and one study did not report details on how included studies were identified and included [20]. The quality of primary studies included in the NMAs was generally reported as good, minimizing the risk of bias, with the exception of non-RCT studies included by Wu et al [44] There appeared to be no evidence of selective reporting of results in primary studies included in the identified NMAs.…”

Section: Nma Analytical Methods and Assessment Of Quality Using Ispormentioning

confidence: 99%

“…Three studies [19,22,43] reported only the rank order of evaluated therapies based on comparative effect sizes and one reported the mean rank, but not its associated uncertainty [20]. Three studies presented rank results as ''rankogram'' plots, illustrating the probability distribution for each treatment's rank [18,25,39]. Nine studies [17,21,23,26,33,34,38,40,44] presented overall rankings based on the Surface Under the Cumulative RAnking curve (SUCRA), which is a numeric representation of overall rank [45].…”

Section: Nma Analytical Methods and Assessment Of Quality Using Ispormentioning

confidence: 99%

“…However, in two NMAs only MEDLINE was searched, [18,19] and in another the search methods were not reported [20]. The search strategies in the identified NMAs were generally comprehensive, with the exception of seven analyses, for which the methods used were likely to miss relevant studies [18,19,[21][22][23][24][25][26]. Risk of bias was assessed using the Jadad scale for randomized controlled trials [27] in six, the Cochrane Collaboration's tool for assessing risk of bias [28] in nine, the Newcastle-Ottawa Scale [29] in one and the NICE methodology checklist for RCTs [9] in two NMAs.…”

Section: Study Identification and Selection In The Nmasmentioning

confidence: 99%

“…Only one analysis [22] did not report on conflicts of interest or source of funding. Two NMAs declared no conflicts of interest including any sources of funding [18,25], two declared conflicts but no source of funding, [43,44] and two reported on potential conflicts but not on sources of funding [19,21]. The remaining eighteen provided details of conflicts of interests and the funding received.…”

Section: Source Of Funding and Conflicts Of Interestmentioning

confidence: 99%

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Assessing the Quality and Coherence of Network Meta-Analyses of Biologics in Plaque Psoriasis: What Does All This Evidence Synthesis Tell Us?

Wright¹,

Yasmeen²,

Malottki³

et al. 2020

Dermatol Ther (Heidelb)

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Introduction A range of treatments are available for moderate-to-severe psoriasis; however, there remains a paucity of direct comparisons of these in head-to-head trials. Network meta-analyses (NMA) allow comparisons of these to support clinical decision making. This systematic literature review assesses the methodological quality of NMAs available for moderate-to-severe psoriasis and compares their methods and results. Their validity and applicability for current practice is also assessed. Methods A systematic review of published NMAs of at least two biologics for moderate-to-severe psoriasis was undertaken. Embase, MEDLINE, MEDLINE In-Process, and the Cochrane Library were last searched on 19 February 2020. The quality of NMAs was assessed using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) criteria. NMA methodology, funding, and results were compared and differences in results explored. Results Twenty-five analyses evaluating up to 19 different treatments at 8–24 weeks, and two analyses at 1 year, were included. Psoriasis Area Severity Index (PASI) response was assessed in 23, facilitating comparisons between NMAs. All NMAs met at least half of the ISPOR criteria. The major limitations were explaining the rationale for methodology, exploring effect modifiers, and consistency between direct and indirect estimates. The analyses differed in model type (Bayesian or frequentist), analysis of PASI response (binomial or multinomial), and analysis of different treatment doses (separate or pooled). PASI results were broadly similar, except for the Cochrane Collaboration NMA which provided lower estimates of treatment efficacy versus placebo. This analysis differed methodologically from others, including pooling data for different doses. Conclusions Based on PASI 90 at induction, the majority of recent NMAs came to similar conclusions: interleukin (IL) 17 inhibitors (brodalumab, ixekizumab, secukinumab), IL-23 inhibitors (guselkumab and risankizumab) and infliximab were most efficacious, supporting the validity of NMAs in this clinical area. Decisions should be made using high-quality, up-to-date NMAs with assumptions relevant to clinical practice. Electronic supplementary material The online version of this article (10.1007/s13555-020-00463-y) contains supplementary material, which is available to authorized users.

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Comparison of Biologics and Oral Treatments for Plaque Psoriasis

et al. 2020

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The clinical benefits of novel treatments for moderate to severe psoriasis are well established, but wide variations exist in patient response across different therapies. In the absence of head-to-head randomized trials, meta-analyses synthesizing data from multiple studies are needed to assess comparative efficacy among psoriasis treatments.OBJECTIVE To estimate the relative short-term and long-term efficacy of biologics and oral agents for the treatment of moderate to severe psoriasis.DATA SOURCES A systematic literature review was conducted on December 4, 2017, and updated on September 17, 2018. The Embase, MEDLINE, and Cochrane Central Register databases were included.STUDY SELECTION Phase 2, 3, or 4 randomized clinical trials of treatments licensed by the US Food and Drug Administration and the European Medicines Agency for adults with moderate to severe psoriasis with data on Psoriasis Area and Severity Index assessment of 75%, 90%, and 100% reductions (PASI 75, 90, and 100) at 10 to 16 weeks (short-term efficacy) or 44 to 60 weeks (long-term efficacy) from baseline.DATA EXTRACTION AND SYNTHESIS Data were extracted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A bayesian network meta-analysis was conducted to estimate short-term PASI response rates; to account for variation across trials, an ordinal model that adjusted for reference arm response was implemented. The long-term PASI rates were estimated via a traditional meta-analysis. PASI 75,90, and 100 response rates at 10 to 16 weeks and 44 to 60 weeks from baseline. MAIN OUTCOMES AND MEASURES RESULTSSixty trials meeting all inclusion criteria were included. At weeks 10 to 16, the highest PASI 90 rates were seen with risankizumab-rzaa (71.6%; 95% credible interval [CrI], 67.5%-75.4%), brodalumab (70.8%; 95% CrI, 66.8%-74.6%), ixekizumab (70.6%; 95% CrI, 66.8%-74.6%), and guselkumab (67.3%; 62.5%-71.9%). At weeks 44 to 60, the treatments with the highest PASI 90 rates were risankizumab-rzaa (79.4%, 95% CI, 75.5%-82.9%), guselkumab (76.5%; 95% CI, 72.1%-80.5%), brodalumab (74.0%; 95% CI, 69.3%-78.1%), and ixekizumab (73.9%; 95% CI, 69.9%-77.5%). Findings were consistent for short-term and long-term PASI 75 and 100 responses. CONCLUSIONS AND RELEVANCEThis study provides an assessment of the comparative efficacy among treatments for moderate to severe plaque psoriasis. The meta-analysis suggests that brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa were associated with the highest PASI response rates in both short-term and long-term therapy.

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Comparative efficacy and safety of thirteen biologic therapies for patients with moderate or severe psoriasis: A network meta-analysis

Cited by 28 publications

References 77 publications

Efficacy of Brodalumab for Moderate to Severe Plaque Psoriasis: A Canadian Network Meta-Analysis

Efficacy of Brodalumab for Moderate to Severe Plaque Psoriasis: A Canadian Network Meta-Analysis

Assessing the Quality and Coherence of Network Meta-Analyses of Biologics in Plaque Psoriasis: What Does All This Evidence Synthesis Tell Us?

Comparison of Biologics and Oral Treatments for Plaque Psoriasis

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