Are biologics combined with methotrexate better than biologics monotherapy in psoriasis and psoriatic arthritis: A meta-analysis of randomized controlled trials.

To investigate if the combination of biologics with methotrexate (MTX) would have better performance than biological monotherapy in clinical efficiency and safety for the treatment of psoriasis and psoriatic arthritis (PsA)， a systematic review of randomized controlled trials (RCTs) searched from the Pubmed, Cochrane Library, and Embase was conducted. Psoriasis Area and Severity Index (PASI) responses (including PASI 50, 75, and 90), and proportion of patients with Physician's Global Assessment Scale (sPGA) scored 0 or 1, were used for psoriasis assessment. The American College of Rheumatology (ACR)20/50/70 responder indices were used to assess the efficiency for treating PsA. The incidences of adverse events and antidrug antibodies' development were also recorded. A total of 15 studies with 4221 patients were included in this study. Three of the 15 RCTs were categorized as low risk of bias, nine studies as unclear, and three as high. Significant greater improvement in the combination group than monotherapy group for psoriasis was observed at week 12, week 24, and week 48, with no increased risk of severe adverse events and drug withdrawals due to adverse events. There was no significant difference in the comparison of clinical efficiency for the treatment of PsA at week 24. In conclusion, biologics plus MTX made better performance on improving the clinical efficiency for the treatment of psoriasis when compared with biologic monotherapy, without a difference in tolerability. However, this combination cannot improve the clinical efficiency of PsA treatment and more studies are warranted to elucidate relevant problems.