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Comparative Study
. 2020 Mar 1;156(3):258-269.
doi: 10.1001/jamadermatol.2019.4029.

Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-analysis

April W Armstrong  1 , Luis Puig  2 , Avani Joshi  3 , Martha Skup  3 , David Williams  3 , Junlong Li  4 , Keith A Betts  5 , Matthias Augustin  6
Affiliations
Comparative Study

Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-analysis

April W Armstrong et al. JAMA Dermatol. .

Abstract

Importance: 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.

Main outcomes and measures: PASI 75, 90, and 100 response rates at 10 to 16 weeks and 44 to 60 weeks from baseline.

Results: Sixty 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 relevance: This 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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Armstrong reported receiving grants and personal fees from AbbVie, Eli Lilly, Leo Pharma, and Novartis Pharmaceuticals Corp; personal fees from Boehringer Ingelheim/Parexel, Bristol-Myers Squibb, Celgene, Dermavant, Janssen Pharmaceuticals Inc, Merck, Modernizing Medicine, Ortho Dermatologics, Pfizer Inc, Regeneron Pharmaceuticals, Sanofi Genzyme, Science 37 Inc, Genentech, GlaxoSmithKline, and Valeant; and grants from Dermira, Janssen-Ortho Inc, Kyowa Hakko Kirin, and UCB Pharma outside the submitted work. Dr Puig reported receiving grants and personal fees from AbbVie during the conduct of the study; grants and personal fees from Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Regeneron, Sanofi, Roche, and UCB outside the submitted work; and personal fees from Sandoz, Merck-Serono, MSD, Mylan, and Samsung-Bioepis. Dr Joshi is an employee AbbVie during the conduct of the study. Dr Skup is an employee AbbVie. Dr Williams is an of AbbVie. Dr Li reported receiving grants from AbbVie during the conduct of the study outside the submitted work. Dr Betts reported receiving consultancy fees from AbbVie Inc. during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Screening and Selection Flow
NMA indicates network meta-analysis.
Figure 2.
Figure 2.. Evidence Network for Network Meta-analysis (NMA) of Short-term Psoriasis Area and Severity Index (PASI) (Base Case)
The reference citations for the NMA are as follows: PSOR-010/LIBERATE: reference 20; CIMPASI-1: reference 65; CIMPASI-2: reference 65; CIMPACT: reference 66; reSURFACE-1: reference 68; Papp 2005: reference 38; reSURFACE-2: reference 68; PSOR-008/ESTEEM-1: reference 71; PSOR-009/ESTEEM-2: reference 72; PSOR-005: reference 73; Ohtsuki 2017: reference 74; NCT00245765: reference 67; Papp 2015: reference 69; Leonardi 2003: reference 37; van de Kerkhof 2008: reference 39; Gottlieb 2003: reference 40; EXPRESS: reference 41; EXPRESS II: reference 42; SPIRIT: reference 43; Chaudhari 2001: reference 44; Torii 2010: reference 45; Yang 2012: reference 46; BRIDGE: reference 31; VOYAGE-1: reference 17; VOYAGE-2: reference 18; ORION: reference 60; Ohtsuki 2018: reference 61; LOTUS: reference 54; PEARL: reference 55; PHOENIX 1: reference 56; PHOENIX 2: reference 57; Igarashi 2012: reference 58; Asahina 2010: reference 30; Bissonnette 2013: reference 31; REVEAL: reference 32; CHAMPION: reference 33; Gordon 2006: reference 34; Cai 2017: reference 35; X-PLORE: reference 58; ACCEPT: reference 53; Nakagawa 2016: reference 62; Papp 2012: reference 63; AMAGINE-1: reference 64; AMAGINE-2: reference 19; AMAGINE-3: reference 19; ERASURE: reference 50; FEATURE: reference 51; FIXTURE: reference 50; JUNCTURE: reference 52; UltIMMa-1: reference 15; UltIMMa-2: reference 15; IMMhance: reference 83; UNCOVER 1: reference 47; UNCOVER 2: reference 48; UNCOVER 3: reference 48; VIP-U: reference 59; IMMvent: reference 21; CLEAR: reference 13; CLARITY: reference 26; and IXORA-S: reference 16.
Figure 3.
Figure 3.. Estimated Number Needed to Treat (95% Credible Interval) Relative to Placebo for Short-term Psoriasis Area and Severity Index (PASI) (Base Case)
PASI 75, 90, 100, indicates 75%, 90%, or 100% decrease from baseline.
Figure 4.
Figure 4.. Estimated Response Rate From the Meta-analysis of Long-term Placebo for Short-term Psoriasis Area and Severity Index (PASI) (Base Case)
See this image and copyright information in PMC

Comment in

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