Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis

Sbidian, É.; Chaimani, Anna; García‐Doval, I.; Doney, Liz; Dressler, Corinna; Hua, Camille; Hughes, Carolyn; Naldi, Luigi; Afach, Sivem; Cléach, L. Le

doi:10.1002/14651858.cd011535.pub3

Cited by 178 publications

(275 citation statements)

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“…[32][33][34] Lastly, apremilast appeared to be less effective than biologics in a short-term assessment. 9 Taken as a whole, these findings show low persistence rates at 1 year, higher risk of discontinuation for apremilast-treated patients than for methotrexate-treated patients regardless of the previous systemic therapeutics received, and both being less effective than biologics and having a poor safety profile. Overall, these findings raise the question of whether apremilast is still a valid treatment option for patients with psoriasis, except for patients with contraindications to other systemic agents.…”

Section: Discussionmentioning

confidence: 77%

“…However, in a recent Cochrane review and network meta-analysis, biologics [anti-interleukin (IL)-17, anti-IL-23 and anti-IL-12/23 antibodies] were found to be significantly more effective in achieving ≥ 90% improvement in Psoriasis Area and Severity Index than apremilast in a homogeneous study population. 9 Likewise, other studies have not found a significant difference in efficacy between apremilast and conventional systemic agents (including methotrexate). 9,10 However, these study populations differed in the previous therapeutic lines received, which restricts extrapolation of the corresponding results.…”

mentioning

confidence: 97%

“…9 Likewise, other studies have not found a significant difference in efficacy between apremilast and conventional systemic agents (including methotrexate). 9,10 However, these study populations differed in the previous therapeutic lines received, which restricts extrapolation of the corresponding results. 4,5,11 In contrast to the patients in apremilast trials, most of the patients in methotrexate trials had not previously been treated with biologics or methotrexate.…”

mentioning

confidence: 97%

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Persistence of apremilast in moderate‐to‐severe psoriasis: a real‐world analysis of 14 147 apremilast‐ and methotrexate‐naive patients in the French National Health Insurance database

et al. 2019

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Summary Background Real‐world data on the persistence of apremilast vs. methotrexate are inconclusive. Objectives To assess and compare the long‐term persistence of apremilast and methotrexate in a large cohort of patients with psoriasis. Methods All adult patients with psoriasis registered in the French national health insurance database (‘Système National des Données de Santé’) between 2009 and 2017 were eligible for inclusion. The study population comprised apremilast‐ and methotrexate‐naive patients, defined as those with a first prescription of apremilast or methotrexate. Levels of persistence were compared using a Cox model with propensity‐score matching that included potential confounders (notably age, sex, psoriatic arthritis, comorbidities and previous exposure to topical and systemic treatments). Results In this nationwide population‐based cohort, 14 147 adult patients with psoriasis (mean age 52·3 years, 55·2% male) were found to be naive to both apremilast and methotrexate. After propensity‐score matching, two subgroups of 4805 patients with similar baseline characteristics were included, of whom 3207 apremilast‐treated patients and 2736 methotrexate‐treated patients discontinued their treatment. Kaplan–Meier survival propensity‐score analyses revealed a discontinuation rate of 69% for apremilast and 59% for methotrexate in the first year of treatment. Apremilast‐treated patients had a higher risk of discontinuation than methotrexate‐treated patients when considering the study population as a whole (hazard ratio 1·28, 95% confidence interval 1·23–1·34) or in a propensity‐score‐matched analysis (hazard ratio 1·34, 95% confidence interval 1·27–1·41; P < 0·001). Conclusions Our real‐world data suggest that in the first year of treatment, the discontinuation rate was significantly higher for apremilast‐treated patients than for methotrexate‐treated patients, regardless of the previous therapeutic lines received. What's already known about this topic? Psoriasis is a common chronic, relapse–remitting, inflammatory skin disease associated with severe psychosocial impact. Apremilast, a phosphodiesterase 4 inhibitor, is one of the most recently commercialized psoriasis drugs. Little is known about the long‐term clinical effectiveness of apremilast. What does this study add? The discontinuation rate at 1 year for apremilast was 69%, compared with 58% for methotrexate, in a nationwide population‐based cohort including 14 147 nonselected adult patients with psoriasis. Patients in the apremilast cohort had a higher risk of discontinuation than patients in the methotrexate cohort using propensity‐score matching, including potentially relevant individual risk factors such as age, sex, comorbidities and psoriatic arthritis, and regardless of the previous therapeutic lines received. In daily practice, physicians should take these results into account when choosing between methotrexate and apremilast as a first‐line systemic therapy.

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Section: Discussionmentioning

confidence: 77%

mentioning

confidence: 97%

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confidence: 97%

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Persistence of apremilast in moderate‐to‐severe psoriasis: a real‐world analysis of 14 147 apremilast‐ and methotrexate‐naive patients in the French National Health Insurance database

et al. 2019

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“…Indeed, in randomized controlled trials of these conventional treatments, the risk difference between the active treatment and placebo groups for achieving a 75% improvement in the initial Psoriasis Area Severity Index (PASI 75) at weeks 12 to 16 varied from 30% to 50%. 5 In the mid-2000s, the introduction of biologics targeting key inflammatory cytokines (TNF-a, IL-12, IL-17 and IL-23) improved the short-term outcomes of patients with moderate-to-severe psoriasis. Indeed, the risk difference for achieving PASI 75 at week 12 to 16 ranges from 50% to 85% with these new biologics.…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the risk difference for achieving PASI 75 at week 12 to 16 ranges from 50% to 85% with these new biologics. 5 This efficacy seemed to persist over time, as evidenced by high drug survival rates in national cohorts. 6,7 However, to the best of our knowledge, an association between the increased use of biologics and a fall in the number of hospitalizations for psoriasis flares has not been reported.…”

Section: Introductionmentioning

confidence: 99%

Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015

Polivka

Oubaya

Bachelez

et al. 2018

Acad Dermatol Venereol

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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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Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis

Abstract: Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis (Review)

Cited by 178 publications

References 525 publications

Persistence of apremilast in moderate‐to‐severe psoriasis: a real‐world analysis of 14 147 apremilast‐ and methotrexate‐naive patients in the French National Health Insurance database

Persistence of apremilast in moderate‐to‐severe psoriasis: a real‐world analysis of 14 147 apremilast‐ and methotrexate‐naive patients in the French National Health Insurance database

Trends in hospitalization rates for psoriasis flares since the introduction of biologics: a time series in France between 2005 and 2015

Comparison of Biologics and Oral Treatments for Plaque Psoriasis

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