Cumulative Clinical Benefits of Biologics in the Treatment of Patients with Moderate-to-Severe Psoriasis over 1 Year: a Network Meta-Analysis

Abstract

Introduction: Both early clinical improvement and long-term maintenance of clinical efficacy of treatments matter to patients with psoriasis. We compared cumulative clinical benefits of treatment with biologics over 1 year based on the area under the curve (AUC) for Psoriasis Area and Severity Index (PASI) 100 and PASI 90 responses in patients with moderate-to-severe psoriasis using a network meta-analysis (NMA). Methods: Published phase 3 randomized, placebo-or active-controlled clinical trial data for biologics approved for the treatment of moderate-to-severe psoriasis were obtained from a systematic literature review up to 30 September 2020. Eighteen clinical trials that included data from baseline to 48 or 52 weeks where AUC could be calculated were included. Data were compared using a fixed-effect model with a separate random-effect baseline model to account for effects of the placebo arm. Cumulative clinical benefit was estimated using the AUC for PASI 100 and PASI 90 responses (complete and almost-complete skin clearance, respectively). Normalized AUC was compared using Bayesian NMA. Cumulative days of response were calculated using normalized AUC and study duration. Results: Interleukin (IL)-17 and IL-23 inhibitors demonstrated greater cumulative clinical benefits for both PASI 100 and PASI 90 versus IL-12/ 23 and tumor necrosis factor inhibitors. Over 52 weeks, cumulative days with PASI 100 were greatest with ixekizumab [158.7 (95% credible interval, 147.4, 170.0) days] followed by risankizumab [154.0 (144.9, 163.4) days]; PASI 90 days were greatest with risankizumab [249.3 (239.5, 259.2) days] followed by ixekizumab [238.8 (227.1, 250.8) days]. Both ixekizumab

IL-17 and -23 Inhibitors for the Treatment of Psoriasis

“…3 Ixekizumab has shown the highest cumulative clinical benefits for complete skin clearance and the highest cumulative days at PASI100 (23 weeks of the year) relative to guselkumab, secukinumab, and TNF-ɑ inhibitors. 6 Ixekizumab also has the best patient satisfaction, attitude, and self-reported improvement scores compared to secukinumab and ustekinumab. 12 In a real-life retrospective observational study, ixekizumab led to a rapid and progressive improvement in average PASI and patient satisfaction, and the clinical results were maintained for up to 4 years of continuous treatment.…”

“…3 Given the multitude of treatment options, a host of factors must be considered when choosing the best regimen. [4][5][6][7] Of these, adherence, patient satisfaction, and preference are significant and heavily interlaced. 6,8,9 Medication adherence is the degree to which a person's behaviour corresponds with the agreed recommendations from a healthcare provider.…”

“…[4][5][6][7] Of these, adherence, patient satisfaction, and preference are significant and heavily interlaced. 6,8,9 Medication adherence is the degree to which a person's behaviour corresponds with the agreed recommendations from a healthcare provider. 4,10 Patient preferences and satisfaction play a key role in medication adherence, and should be taken into account so the goals and perceptions of both the patient and physician are in alignment.…”

“…4,10 Patient preferences and satisfaction play a key role in medication adherence, and should be taken into account so the goals and perceptions of both the patient and physician are in alignment. 6,8,11,12 These variables can be quantified using surrogate measures such as efficacy, safety, cost, persistence rate, and discontinuation rate. 4 The Psoriasis Area and Severity Index (PASI) score is used to quantify the severity of psoriasis by rating three variables (erythema, induration, and scale of psoriatic plaques) to produce a score ranging from 0 to 72.…”

Blocking interleukin‐17 in psoriasis: Real‐world experience from the PsoPlus cohort

“…inhibitor ustekinumab (UST), in both short and long term. 1,3,4,[9][10][11][12][13][14] However, data from daily practice and/or registries might better reflect the real-world effectiveness of biologics. In particular, drug survival is a representative measure for therapy effectiveness in the real-world setting.…”