Cochrane Database Syst Rev

Biologics lead in psoriasis symptom control, Cochrane review finds

August 15, 2025

For induction therapy in moderate-to-severe plaque psoriasis, biologics, especially bimekizumab, infliximab, ixekizumab, and risankizumab, offer the greatest likelihood of achieving Psoriasis Area and Severity Index (PASI) 90. However, long-term safety and effectiveness remain uncertain.

Study details: This 2025 Cochrane network meta-analysis included 204 randomized trials (67,889 adults; mean age, 44.4 years; mean baseline PASI, 20.5) with moderate to severe plaque psoriasis, comparing 26 systemic pharmacological treatments (non-targeted, targeted synthetic, and biologic agents) over 8 to 24 weeks. Outcomes were PASI 90 achievement and serious adverse events (SAEs). Study quality was variable, with 31% of efficacy studies and 57% of safety studies at high risk of bias. Most trials were multicentric and industry-funded.

Results: All systemic interventions outperformed placebo for PASI 90. Anti-IL-17 biologics (bimekizumab, ixekizumab, secukinumab, brodalumab, sonelokimab), anti-IL-23 agents (risankizumab, guselkumab), anti-IL-12/23 (ustekinumab), and anti-TNF-α (infliximab, adalimumab, certolizumab, etanercept) were superior to non-targeted and targeted synthetic agents. The highest surface under the cumulative ranking curve (SUCRA)-ranked drugs for PASI 90 were infliximab, xeligekimab, bimekizumab, ixekizumab, and risankizumab, with bimekizumab supported by high-certainty evidence. No significant differences in SAEs vs. placebo were detected, but safety data were limited by low event rates and low-certainty evidence.

Source:

Sbidian E, et al. (2025, August 6). Cochrane Database Syst Rev. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40767824/