Efficacy of Biologics Targeting Tumour Necrosis Factor-alpha, Interleukin-17 -12/23, -23 and Small Molecules Targeting JAK and PDE4 in the Treatment of Nail Psoriasis: A Network Meta-analysis

Abstract

The comparative efficacy of registered anti-psoriatic biologics and small molecules in treating nail symptoms has not been systematically evaluated. The aim of this study was to perform a network meta-analysis to determine the efficacy of biologics and small mole-cules in nail psoriasis. A Bayesian network meta- analysis of 17 randomized clinical trials (a total of 6,053 nail psoriatic patients) was performed, comparing the short-term (week 10-16) efficacy of biologics and small molecules in the treatment of nail psoriasis. All active treatments were found to be superior to place-bo. Ixekizumab 80 mg every 4 weeks (Nail Psoriasis Severity Index (NAPSI) % improvement, Surface Under the Cumulative Ranking (SUCRA)=0.92) and etanercept 50 mg twice weekly (probability of achiev-ing NAPSI 50, SUCRA=0.82) proved the best short-term treatment options. However, efficacy end-points in psoriasis trials were not optimized for nail assessment, and outcome parameters were highly heterogeneous, limiting comparability. In conclusion, outcome parameters and efficacy endpoints of nail psoriasis trials should be standardized.

Keywords: Nail Psoriasis Severity Index; biologics; efficacy; network meta-analysis; nail psoriasis.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.

Fig. 2

Network of interventions. The edges demonstrate direct (head-to-head) comparisons of interventions. The nodes represent interventions. The width of the edges and the size of the nodes are proportional to the sample size of the trials. (a) Nail Psoriasis Severity Index (NAPSI) percentage improvement from baseline at week 10–16. Fifteen interventions including placebo were analysed. (b) Number of patients achieving at least 50% reduction in NAPSI (NAPSI 50). Nine interventions including placebo were analysed.