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Review
. 2025 Apr 1;15(2):4793.
doi: 10.5826/dpc.1502a4793.

Biologic and Non-Biologic Therapies for Scalp Psoriasis: A Network Meta-analysis of Randomized Controlled Trials

Hargun Kaur  1 , Tara Behroozian  1 , Rafael Paolo Lansang  1 , Saverio Caini  2 , Chiara Doccioli  3 , Mohannad Abu-Hilal  4
Affiliations
Review

Biologic and Non-Biologic Therapies for Scalp Psoriasis: A Network Meta-analysis of Randomized Controlled Trials

Hargun Kaur et al. Dermatol Pract Concept. .

Abstract

Introduction: Scalp psoriasis affects up to 80% of patients with plaque-type psoriasis and is often resistant to topical and conventional systemic agents. There is a lack of consensus on a "gold standard" treatment.

Objective: This comprehensive review and network meta-analysis aimed to compare the efficacy and safety of studied interventions.

Methods: The Ovid MEDLINE(R), Embase, and Cochrane databases were searched from 01 January 2000 to 05 October 2022. All English-language randomized controlled trials evaluating an intervention for scalp psoriasis were included if they reported one of the following clinical outcomes: Psoriasis Scalp Severity Index (PSSI), scalp Physician Global Assessment (ScPGA), scalp-specific Investigator or Physician Global Assessment (IGA/PGA), and Total Sign Score (TSS), and adverse events. A random effects network meta-analysis was performed where possible, and network plots were generated.

Results: Of 1,046 studies identified, 35 met the inclusion criteria, with seven in the PSSI analysis and 16 in the IGA analysis. All interventions led to an improvement in all outcomes when compared to placebo in the PSSI and PGA/IGA. For the PSSI response, secukinumab 300 mg every four weeks (Q4W) was the most effective (SUCRA 0.991). For the PGA/IGA response, bimekizumab 320 mg Q4W was the most effective (SUCRA 0.975).

Conclusions: Several systemic therapies are superior to placebo in improving clinical outcomes, with secukinumab 300 mg Q4W and bimekizumab 320 mg Q4W deemed the most effective among biologic agents analyzed. Efforts to enhance research standardization, including head-to-head trials with standardized outcome measures, diverse patient recruitment, and long-term follow-up, are crucial next steps in assessing treatment efficacy and adverse events.

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Conflict of interest statement

Competing Interests: TB, HK PL, SC, and DC declare no conflict of interest. MAH has been speaker, advisor, and/or received honoraria from: AbbVie, Biojamp, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Eli Lilly, Galderma, Hikma Pharmaceuticals, Incyte, Janssen, Leo, L’Oreal, La Roche Posay, Medexus, Novartis, Pfizer, Recordati, Sanofi Regeneron, Sun Pharma.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2
(A) Network plot of studies reporting the PSSI response. (B) Forest plot of network meta-analysis results for studies reporting the PSSI response. (PSSI = Psoriasis Scalp Severity Index.)
Figure 3
Figure 3
(A) Network plot of studies reporting the IGA response. (B) Forest plot of network meta-analysis results for studies reporting the IGA response. (IGA = scalp-specific Investigator Global Assessment).
See this image and copyright information in PMC

References

    1. van de Kerkhof PC, de Hoop D, de Korte J, Kuipers MV. Scalp psoriasis, clinical presentations and therapeutic management. Dermatology. 1998;197(4):326–34. doi: 10.1159/000018026. - DOI - PubMed
    1. Crowley J. Scalp psoriasis: an overview of the disease and available therapies. J Drugs Dermatol. 2010;9(8):912–8. - PubMed
    1. Mrowietz U, Macheleidt O, Eicke C. Effective treatment and improvement of quality of life in patients with scalp psoriasis by topical use of calcipotriol/betamethasone (Xamiol®-gel): results. J Dtsch Dermatol Ges. 2011;9(10):825–31. doi: 10.1111/j.1610-0387.2011.07695.x. [published Online First: 20110512] - DOI - PubMed
    1. Wang TS, Tsai TF. Managing Scalp Psoriasis: An Evidence-Based Review. Am J Clin Dermatol. 2017;18(1):17–43. doi: 10.1007/s40257-016-0222-4. - DOI - PubMed
    1. Blakely K, Gooderham M. Management of scalp psoriasis: current perspectives. Psoriasis (Auckl) 2016;6:33–40. doi: 10.2147/ptt.S85330. - DOI - PMC - PubMed

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