Efficacy of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: A Systematic Literature Review and a Network Meta-Analysis

Abstract

Introduction: Biologic treatments are increasingly being used in the management of moderate to severe plaque psoriasis (PSO). Bimekizumab is a selective inhibitor of both interleukin (IL)-17A and IL-17F approved for the treatment of moderate to severe PSO. Although bimekizumab trials provide comparisons to secukinumab, adalimumab and ustekinumab, there are no further head-to-head comparisons of bimekizumab to other biologics. This network meta-analysis (NMA) aimed to compare the short-term efficacy of bimekizumab versus other biologic systemic therapies for moderate to severe PSO.

Methods: A systematic literature review was conducted to identify randomised controlled trials (RCTs) in patients with moderate to severe PSO. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Database of Systematic Reviews and PsycINFO were searched on July 1, 2020. An enhanced multinomial Bayesian NMA model was used to evaluate the comparative efficacy in 50%, 75%, 90% and 100% improvement from baseline Psoriasis Area and Severity Index (PASI 50/75/90/100) at 10-16 weeks. The model was also adjusted for baseline risk, given the variable placebo responses across the trials.

Results: Eighty-six RCTs (including 34,476 patients) were included in the NMA. IL-17 and IL-23 inhibitors were the most effective treatments across all PASI levels. At 10-16 weeks, bimekizumab had the highest probability of achieving PASI 75 (92.3%), PASI 90 (84.0%) and PASI 100 (57.8%). Bimekizumab demonstrated statistical superiority over all biologics in achieving PASI 90 and PASI 100 thresholds. For PASI 75, the benefit of bimekizumab was statistically significant compared to all other treatments except risankizumab and ixekizumab.

Conclusion: This analysis demonstrated that IL-17 and IL-23 inhibitors were highly effective in achieving short-term improvement among patients with moderate to severe PSO. Patients receiving bimekizumab were significantly more likely to achieve PASI 90 or PASI 100 within 10-16 weeks of the first injection than all other biologics.

Keywords: Biologics; Efficacy; Multinomial; Network meta-analysis; Psoriasis.

Fig. 1

PRISMA Flow Diagram of Study Inclusion and Exclusion of Clinical Efficacy and Safety. NMA network meta-analysis, OLE open-label extension, PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses, RCT randomised controlled trial, SLR systematic literature review

Fig. 2

Network diagram for trials reporting PASI outcomes. ACTR acitretin, ADA adalimumab, APR apremilast, BKZ bimekizumab, BRO brodalumab, CSP cyclosporine, CZP certolizumab pegol, DF dimethyl fumarate, ETN etanercept, GUS guselkumab, IL interleukin, IFX infliximab, IXE ixekizumab, MTX methotrexate, PASI Psoriasis Area and Severity Index, PBO placebo, RZB risankizumab, SEC secukinumab, TIL tildrakizumab, TNF tumour necrosis factor, UST ustekinumab

Fig. 3

Probit probabilities (95% CrI) of achieving PASI outcomes (REZ, adjusted, random-effects multinomial model). Treatments are sorted by the highest to lowest probabilities of reaching PASI 75. CrI credible interval, IL interleukin, PASI Psoriasis Area and Severity Index, TNF tumour necrosis factor

Fig. 4

Risk ratios (95% CrI) of achieving PASI 75, PASI 90 and PASI 100 for bimekizumab 320 mg versus other treatments (REZ, adjusted, random-effects multinomial model). Treatments are sorted by the highest to lowest probabilities of reaching PASI 75. CrI credible interval, IL interleukin, PASI Psoriasis Area and Severity Index, TNF tumour necrosis factor