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Comparative Study
. 2020 Feb;6(1):e001117.
doi: 10.1136/rmdopen-2019-001117.

Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis

Adeline Ruyssen-Witrand  1   2 , Richard Perry  3 , Clare Watkins  4 , George Braileanu  5 , Gayathri Kumar  6 , Sandeep Kiri  7 , Debby Nott  7 , Soyi Liu-Leage  8 , Susanne Hartz  9 , Christophe Sapin  10
Affiliations
Comparative Study

Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis

Adeline Ruyssen-Witrand et al. RMD Open. 2020 Feb.

Abstract

Background: Biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs are used in patients with psoriatic arthritis (PsA), but few studies directly compare their clinical efficacy. In such situations, network meta-analysis (NMA) can inform evidence-based decision-making.

Objective: To evaluate the comparative efficacy and safety of approved bDMARDs in patients with PsA.

Methods: Bayesian NMA was conducted to compare the clinical efficacy of bDMARDs at weeks 12‒16 in bDMARD-naïve patients with PsA in terms of American College of Rheumatology (ACR) criteria, Psoriatic Arthritis Response Criteria (PsARC) and Psoriasis Area and Severity Index (PASI). Safety end points were evaluated in the overall mixed population of bDMARD-naive and bDMARD-experienced patients.

Results: For ACR, all treatments except abatacept were statistically superior to placebo. Infliximab was most effective, followed by golimumab and etanercept, which were statistically superior to most other treatments. Ixekizumab 80 mg every 2 weeks (Q2W) was statistically superior to abatacept subcutaneous, apremilast and both regimens of ustekinumab; similar findings were observed for ixekizumab 80 mg Q4W. For PsARC response, ixekizumab did not significantly differ from other therapies, except for golimumab, infliximab and etanercept, which were superior to most other agents including ixekizumab. For PASI response, infliximab was numerically most effective, but was not statistically superior to ixekizumab, which was the next best performing agent. Analysis of safety end points identified few differences between treatments.

Conclusion: Our NMA confirms the efficacy and acceptable safety profile of bDMARDs in patients with active PsA. There were generally few statistically significant differences between most treatments.

Keywords: DMARDs (biologic); DMARDs (synthetic); psoriatic arthritis.

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Conflict of interest statement

Competing interests: AR-W has received honoraria for conferences and as a scientific expert from Abbvie, Amgen, Biogen, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB. RP and GB are full-time employees of Adelphi Values Ltd, and CW of their cooperation partner, Clarostat Consulting Ltd, who were commissioned by Eli Lilly and Company to conduct the analysis for this work. SL-L, GK, CS and SH are full-time employees of Eli Lilly and Company, receive a salary and own company stock. DN and SK were full-time employees of Eli Lilly and Company during the inception of the work.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses flow chart showing study selection. EBM, evidence-based medicine. * Reasons for exclusion included: patient population (n=11); interventions (n=5), comparators (n=1), outcomes (n=55), study design (n=50), other (n=83); in some cases, more than one reason were recorded. ** Breakdown by source: Ovid (Embase/Medline/EBM) (n=127), conference searching (n=55), other and hand searches (n=55), clinical trials databases (n=1).
Figure 2
Figure 2
Network diagram (A) and forest plot of treatment differences on the standard normal scale (B) for ACR response at weeks 12–16 among bDMARD-naïve patients with active PsA (placebo as the reference). In the network diagram, line thickness is weighted according to the number of studies included in the respective comparison between treatment regimens or between drug and placebo (indicated by each line connecting circles). Circle size is weighted according to the total number of studies with the treatment regimen or placebo. ACR, American College of Rheumatology; bDMARD, biologic disease-modifying antirheumatic drug; BID, two times per day; BIW, twice weekly; IV, intravenously; PsA, psoriatic arthritis; QxW, every x weeks; SC, subcutaneously.
Figure 3
Figure 3
Network diagram (A) and forest plot of odds ratios (B) for PsARC at weeks 12–16 among bDMARD-naïve patients with active PsA (placebo as the reference). In the network diagram, line thickness is weighted according to the number of studies included in the respective comparison between treatment regimens or between drug and placebo (indicated by each line connecting circles). Circle size is weighted according to the total number of studies with the treatment regimen or placebo. bDMARD, biologic disease-modifying antirheumatic drug; BID, two times per day; BIW, twice weekly; IV, intravenously; PsA, psoriatic arthritis; PsARC, psoriatic response criteria; QxW, every x weeks; SC, subcutaneously.
Figure 4
Figure 4
Network diagram (A) and forest plot of treatment differences on the standard normal scale (B) for PASI at weeks 12–16 among bDMARD-naïve patients with active PsA (placebo as the reference). In the network diagram, line thickness is weighted according to the number of studies included in the respective comparison between treatment regimens or between drug and placebo (indicated by each line connecting circles). Circle size is weighted according to the total number of studies with the treatment regimen or placebo. bDMARD, biologic disease-modifying antirheumatic drug; BID two times per day; BIW, twice weekly; IV, intravenously; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; QxW, every x weeks; SC, subcutaneously.
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