A G Ellis1,2, C Flohr3, A M Drucker4,5. 1. School of Public Health, Brown University, Providence, RI, U.S.A. 2. Institute for Clinical and Economic Review, Boston, MA, U.S.A. 3. Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, U.K. 4. Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada. 5. Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, Canada.
Abstract
AIM: There are numerous systemic medications in use for psoriasis, with additional investigational agents being studied. However, head-to-head, randomized clinical trials are rare and cannot feasibly compare all treatments. A network meta-analysis (NMA) synthesizes the available evidence to provide estimates for all pairwise comparisons. Here, we summarize and appraise two recent NMAs that assessed systemic therapies for moderate-to-severe psoriasis. SETTING AND DESIGN: Two systematic reviews searched databases and the grey literature to identify relevant randomized clinical trials. STUDY PARTICIPANTS: The reviews mostly included trials that involved adults with moderate-to-severe psoriasis. One of the reviews also included two trials involving children. STUDY EXPOSURE: Interventions common to both reviews include adalimumab, etanercept, infliximab, ustekinumab, ixekizumab, secukinumab and methotrexate. One of the reviews included additional interventions, primarily other biological agents along with new small-molecule treatments and systemic conventional treatments. PRIMARY OUTCOMES: One review focused on 'clear/nearly clear' and withdrawals from adverse events as study outcomes, while the second review focused on improvement of ≥ 90% measured on the Psoriasis Area and Severity Index (PASI 90) and serious adverse events. OUTCOMES: Additional outcomes included quality of life, PASI 75, Physician's Global Assessment of 0/1 and any adverse event. RESULTS: Overall, both NMAs are of high quality and provide a comprehensive summary of the evidence base and treatment effects. Results, in terms of both estimates and rankings, suggest that newer biologics targeting the interleukin (IL)-12/23 and IL-17 axes appear to be more effective than older biologics and oral agents. CONCLUSIONS: Patients, clinicians and policy makers can use the relative efficacy assessments of NMAs to inform decision making regarding the clearance of psoriasis skin lesions at relevant time points and improvement in quality of life.
AIM: There are numerous systemic medications in use for psoriasis, with additional investigational agents being studied. However, head-to-head, randomized clinical trials are rare and cannot feasibly compare all treatments. A network meta-analysis (NMA) synthesizes the available evidence to provide estimates for all pairwise comparisons. Here, we summarize and appraise two recent NMAs that assessed systemic therapies for moderate-to-severe psoriasis. SETTING AND DESIGN: Two systematic reviews searched databases and the grey literature to identify relevant randomized clinical trials. STUDY PARTICIPANTS: The reviews mostly included trials that involved adults with moderate-to-severe psoriasis. One of the reviews also included two trials involving children. STUDY EXPOSURE: Interventions common to both reviews include adalimumab, etanercept, infliximab, ustekinumab, ixekizumab, secukinumab and methotrexate. One of the reviews included additional interventions, primarily other biological agents along with new small-molecule treatments and systemic conventional treatments. PRIMARY OUTCOMES: One review focused on 'clear/nearly clear' and withdrawals from adverse events as study outcomes, while the second review focused on improvement of ≥ 90% measured on the Psoriasis Area and Severity Index (PASI 90) and serious adverse events. OUTCOMES: Additional outcomes included quality of life, PASI 75, Physician's Global Assessment of 0/1 and any adverse event. RESULTS: Overall, both NMAs are of high quality and provide a comprehensive summary of the evidence base and treatment effects. Results, in terms of both estimates and rankings, suggest that newer biologics targeting the interleukin (IL)-12/23 and IL-17 axes appear to be more effective than older biologics and oral agents. CONCLUSIONS:Patients, clinicians and policy makers can use the relative efficacy assessments of NMAs to inform decision making regarding the clearance of psoriasis skin lesions at relevant time points and improvement in quality of life.
Authors: Paul Sator; Robert Loewe; Omid Zamani; Gregor Holzer; Peter Wolf; Alexander Mlynek; Thomas Berger; Leo Richter; Elisabeth Schuller Journal: Wien Klin Wochenschr Date: 2019-10-07 Impact factor: 1.704
Authors: Cathrine Helene Mohn; Hege S Blix; Anja Maria Brænd; Per Nafstad; Ståle Nygard; Jon Anders Halvorsen Journal: Dermatol Ther (Heidelb) Date: 2022-06-28
Authors: Frank Peinemann; Marco Harari; Sandra Peternel; Thalia Chan; David Chan; Alexander M Labeit; Thilo Gambichler Journal: Cochrane Database Syst Rev Date: 2020-05-05
Authors: Laura M Sawyer; Kinga Malottki; Celia Sabry-Grant; Najeeda Yasmeen; Emily Wright; Anne Sohrt; Emma Borg; Richard B Warren Journal: PLoS One Date: 2019-08-14 Impact factor: 3.240
Authors: Vibeke Strand; Joao Gonçalves; Timothy P Hickling; Heather E Jones; Lisa Marshall; John D Isaacs Journal: BioDrugs Date: 2020-02 Impact factor: 5.807
Authors: Gloria-Beatrice Wintermann; Antonie Louise Bierling; Eva M J Peters; Susanne Abraham; Stefan Beissert; Kerstin Weidner Journal: Front Psychiatry Date: 2022-04-25 Impact factor: 4.157
Authors: Jonathan Kay; Vibeke Strand; Alan Menter; Stanley Cohen; Alice Gottlieb; Stephen Hanauer; Sravan Kumar Eduru; Susanne Buschke; Benjamin Lang; Karl-Heinz Liesenfeld; Jennifer Schaible; Dorothy McCabe Journal: Am J Clin Dermatol Date: 2022-08-07 Impact factor: 6.233