Resum: |
The clinical benefits of biologic and oral treatments for moderate-to-severe plaque psoriasis are well-established, but efficacy outcomes can vary across therapies. Comparative efficacy analysis can be highly informative in clinical settings with multiple therapeutic options. This study assessed the short-term and long-term comparative efficacy of biologic and oral treatments for moderate-to-severe psoriasis. A systematic literature review identified phase 2/3/4 randomized controlled trials (RCTs) through to 1 July 2020 for Food and Drug Administration- or European Medicines Agency-licensed treatments for moderate-to-severe psoriasis. Psoriasis Area and Severity Index (PASI) 75/90/100 response rates at the end of the primary response (short-term: 10-16 weeks from baseline) and maintenance periods (long-term: 48-52 weeks from baseline) were estimated using Bayesian network meta-analysis. Surfaces under the cumulative ranking curves (SUCRA) were estimated to present the relative ranking of treatments. In the short term (N = 71 RCTs), the PASI 90 response rates were highest for ixekizumab (72. 9%, SUCRA 0. 951), risankizumab (72. 5%, 0. 940), and brodalumab (72. 0%, 0. 930), which were significantly higher than those for guselkumab (65. 0%, 0. 795), secukinumab (65. 0%, 0. 794), infliximab (56. 8%, 0. 702), certolizumab (400 mg: 49. 6%, 0. 607; 200 mg: 42. 2%, 0. 389), ustekinumab (90 mg: 47. 9%, 0. 568; weight-based: 45. 7%, 0. 505; 45 mg: 44. 6%, 0. 460), adalimumab (43. 0%, 0. 410), tildrakizumab (200 mg: 39. 7%, 0. 327; 100 mg: 37. 2%, 0. 268), etanercept (18. 0%, 0. 171), apremilast (12. 4%, 0. 090), and dimethyl fumarate (12. 2%, 0. 092). The PASI 100 response rates were highest for ixekizumab (41. 4%), risankizumab (40. 8%), and brodalumab (40. 3%). In the long term (N = 11 RCTs), the PASI 90 rate was highest for risankizumab (85. 3%, SUCRA: 0. 998), which were significantly higher than those for brodalumab (78. 8%, 0. 786), guselkumab (78. 1%, 0. 760), ixekizumab (72. 1%, 0. 577), secukinumab (67. 0%, 0. 450), ustekinumab (weight-based: 55. 0%, 0. 252), adalimumab (51. 6%, 0. 176), and etanercept (37. 9%, 0. 001). Risankizumab had the highest PASI 100 response rate (65. 4%), followed by brodalumab (55. 7%) and guselkumab (54. 8%). Ixekizumab, risankizumab, and brodalumab had the highest short-term efficacy, and risankizumab had the highest long-term efficacy. The online version contains supplementary material available at 10. 1007/s13555-021-00511-1. |