Cochrane Database Syst Rev
Chronic plaque psoriasis: Which pharmacologic treatments work best?
The biologics bimekizumab, infliximab, ixekizumab, and risankizumab were more effective than other systemic drugs (and placebo) at achieving clear/almost clear skin in adults with chronic plaque psoriasis (high‐certainty evidence); these drugs had similar clinical effectiveness when compared head to head.
- This network meta‐analysis of RCTs on systemic psoriasis treatment induction included 179 studies (N=62,339; 67% male; average age, 44.6 years old) of 2-6 months duration. Most patients were recruited from hospitals; mean baseline Psoriasis Area and Severity Index (PASI) was 20.4. The primary outcome was 90% improvement in PASI score (i.e., PASI 90).
- Drug comparisons: Reaching goal was significantly more likely with bimekizumab and ixekizumab vs. secukinumab. Bimekizumab, ixekizumab, and risankizumab were significantly more likely to result in PASI 90 than brodalumab and guselkumab. Use of infliximab, bimekizumab, ixekizumab, secukinumab, brodalumab, and anti‐IL23 agents (other than tildrakizumab) were significantly more likely to reach goal vs. ustekinumab, 3 anti‐TNF alpha agents, or deucravacitinib. Ustekinumab was considered superior to certolizumab; and adalimumab, tildrakizumab, and ustekinumab superior to etanercept. No significant differences were noted between apremilast vs. ciclosporin and methotrexate.
- Adverse events. Evidence on serious adverse events was mostly very low to moderate in quality and based on a small number of events. Studies were 2-6 months long; additional studies are warranted to assess potential harms of longer durations of therapy.
Source:
Sbidian E, et al. (2023, July 12). Cochrane Database Syst Rev. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/37436070/