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. 2021 Dec;11(6):1965-1998.
doi: 10.1007/s13555-021-00602-z. Epub 2021 Sep 22.

Short-Term Efficacy of Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: A Systematic Literature Review and an Enhanced Multinomial Network Meta-Analysis

Kyle Fahrbach  1 , Grammati Sarri  2 , David M Phillippo  3 , Binod Neupane  4 , Samantha E Martel  4 , Sandeep Kiri  5 , Kristian Reich  6
Affiliations

Short-Term Efficacy of Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: A Systematic Literature Review and an Enhanced Multinomial Network Meta-Analysis

Kyle Fahrbach et al. Dermatol Ther (Heidelb). 2021 Dec.

Abstract

Introduction: Many targeted, systemic therapies have been developed for treatment of moderate-to-severe psoriasis (PsO). A network meta-analysis (NMA) allows for comparison between treatments not directly compared in randomized controlled trials (RCT). This study's objective was to compare the short-term (10-16 weeks) clinical efficacy according to the Psoriasis Area and Severity Index (PASI) among approved biologic treatments for moderate-to-severe PsO using a novel (enhanced) NMA model.

Methods: A systematic literature review (SLR) of RCTs for patients with moderate-to-severe PsO was conducted. English publications in MEDLINE, Embase, and The Cochrane Library up to March 2019 were searched. An enhanced multinomial Bayesian NMA was performed to simultaneously adjust for baseline risk and utilize the conditional nature of the PASI (50, 75, 90, and 100) levels. The model relaxes typical constraints that all treatments must have the same ranks across PASI levels.

Results: The SLR resulted in 319 relevant publications, of which 72 publications from 73 RCTs reporting 10- to 16-week data for at least one PASI response level (30,314 total patients) were included. Interleukin (IL) inhibitors (risankizumab, ixekizumab, brodalumab, secukinumab, and guselkumab) were the best performing treatments for achieving all PASI levels. Etanercept was outperformed by the other subcutaneous tumor necrosis factor α inhibitors. Application of an enhanced NMA model that allowed treatment rankings to differ by PASI level tested the robustness of results of previous NMAs in PsO.

Conclusion: The results of this model confirmed that IL inhibitors are likely the best short-term treatment choices for improving all PASI levels.

Keywords: Biologic treatment; Efficacy; Network meta-analysis; Psoriasis.

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Figures

Fig. 1
Fig. 1
Placebo response rates across the trials for PASI75
Fig. 2
Fig. 2
Preferred reporting items for systematic reviews and meta-analysis flow chart
Fig. 3
Fig. 3
PASI (10–16 weeks) NMA network
Fig. 4
Fig. 4
Predicted probabilities of achieving PASI responses at 10–16 weeks in baseline adjusted REZ random effects multinomial model. Treatments are sorted by the highest to lowest estimates of probabilities of reaching PASI75
Fig. 5
Fig. 5
SUCRA* plot of treatments achieving each PASI threshold in baseline adjusted REZ random-effects multinomial model
See this image and copyright information in PMC

References

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