Efficacy of several biological therapies for treating moderate to severe psoriasis: A network meta-analysis

Abstract

The aim of the present meta-analysis was to systematically assess the efficacy of the various treatments available for moderate to severe psoriasis. PubMed and Embase databases were systematically searched to select relevant studies up to February 2015. Odds ratios (ORs) and their 95% confidence intervals (CIs) were used as effect estimates. In addition, the Psoriasis Area and Severity Index (PASI) 50, PASI 75 and PASI 90 responses for the therapies were systematically assessed. A total of 33 randomized controlled trials were included in the present study. For the PASI 75 response rate, infliximab (5 mg) may be the most effective option for the treatment of moderate to severe psoriasis. Furthermore, the pooled results of the PASI 50 response rate demonstrated that infliximab (5 mg) and ustekinumab (90 mg) may be superior to other drugs for treating moderate to severe psoriasis. For the PASI 90 response rate, infliximab (5 mg), ustekinumab (90 mg) and briakinumab (weeks 0 and 4, 200 mg; week 8, 100 mg) exhibited improved results compared with other treatments. In conclusion, infliximab (5 mg) may be a superior option to treat moderate to severe psoriasis due to the relatively high PASI scores. However, despite the high PASI 90 responses, further studies are required to identify the efficacy of ustekinumab (90 mg) and briakinumab.

Keywords: Psoriasis Area and Severity Index; biological therapies; network meta-analysis; psoriasis.

Figure 1.

Process of the literature selection performed in the present meta-analysis. RCT, randomized controlled trial.

Figure 2.

Risk of bias of the included studies. +, low risk of bias; ?, unclear risk of bias; -, high risk of bias. The quality evaluation map indicates that, regarding random sequence generation (selection bias) and allocation concealment (selection bias), many references have an unclear risk of bias and few references have high risk of bias. However, regarding incomplete outcome data (attrition bias), blinding of participants and personnel (performance bias) and blinding of outcome assessment (detection bias), ~10% references have high risk of bias and 10% references have an unclear risk of bias. The included references showed no evidence of selective reporting (reporting bias) in the included references-all references showed a low risk of bias.

Figure 3.

Network of PASI 75 response rate. The figures on the blue edges refer to the comparison times. PASI, Psoriasis Area and Severity Index. Image generated using ADDIS software 1.16.5.