Want to take quizzes and track your credits?
What is the short-term and long-term comparative efficacy among biologics and oral agents for plaque psoriasis?
In a network meta-analysis of 60 clinical trials for short-term efficacy, brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa had the highest Psoriasis Area and Severity Index response rates at 10 to 16 weeks from baseline. A meta-analysis of long-term efficacy suggested that brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa had the highest response rates at 44 to 60 weeks.
This study provides an assessment of both short-term and long-term comparative efficacy among treatments for moderate to severe plaque psoriasis which can help health care stakeholders optimize treatment regimens.
The clinical benefits of novel treatments for moderate to severe psoriasis are well established, but wide variations exist in patient response across different therapies. In the absence of head-to-head randomized trials, meta-analyses synthesizing data from multiple studies are needed to assess comparative efficacy among psoriasis treatments.
To estimate the relative short-term and long-term efficacy of biologics and oral agents for the treatment of moderate to severe psoriasis.
A systematic literature review was conducted on December 4, 2017, and updated on September 17, 2018. The Embase, MEDLINE, and Cochrane Central Register databases were included.
Phase 2, 3, or 4 randomized clinical trials of treatments licensed by the US Food and Drug Administration and the European Medicines Agency for adults with moderate to severe psoriasis with data on Psoriasis Area and Severity Index assessment of 75%, 90%, and 100% reductions (PASI 75, 90, and 100) at 10 to 16 weeks (short-term efficacy) or 44 to 60 weeks (long-term efficacy) from baseline.
Data Extraction and Synthesis
Data were extracted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A bayesian network meta-analysis was conducted to estimate short-term PASI response rates; to account for variation across trials, an ordinal model that adjusted for reference arm response was implemented. The long-term PASI rates were estimated via a traditional meta-analysis.
Main Outcomes and Measures
PASI 75, 90, and 100 response rates at 10 to 16 weeks and 44 to 60 weeks from baseline.
Sixty trials meeting all inclusion criteria were included. At weeks 10 to 16, the highest PASI 90 rates were seen with risankizumab-rzaa (71.6%; 95% credible interval [CrI], 67.5%-75.4%), brodalumab (70.8%; 95% CrI, 66.8%-74.6%), ixekizumab (70.6%; 95% CrI, 66.8%-74.6%), and guselkumab (67.3%; 62.5%-71.9%). At weeks 44 to 60, the treatments with the highest PASI 90 rates were risankizumab-rzaa (79.4%, 95% CI, 75.5%-82.9%), guselkumab (76.5%; 95% CI, 72.1%-80.5%), brodalumab (74.0%; 95% CI, 69.3%-78.1%), and ixekizumab (73.9%; 95% CI, 69.9%-77.5%). Findings were consistent for short-term and long-term PASI 75 and 100 responses.
Conclusions and Relevance
This study provides an assessment of the comparative efficacy among treatments for moderate to severe plaque psoriasis. The meta-analysis suggests that brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa were associated with the highest PASI response rates in both short-term and long-term therapy.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: October 25, 2019.
Corresponding Author: April W. Armstrong, MD, MPH, Department of Dermatology, Keck School of Medicine, University of Southern California, HC4 2000, 1450 San Pablo, Health Sciences Campus, Los Angeles, CA 90033 (email@example.com).
Published Online: February 5, 2020. doi:10.1001/jamadermatol.2019.4029
Author Contributions: Drs Li and Betts had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Armstrong, Joshi, Skup, Li, Betts, Augustin.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Armstrong, Joshi, Skup, Williams, Li, Betts.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Armstrong, Puig, Joshi, Li, Betts.
Administrative, technical, or material support: Joshi, Williams.
Supervision: Armstrong, Puig, Joshi, Skup, Williams, Betts, Augustin.
Conflict of Interest Disclosures: Dr Armstrong reported receiving grants and personal fees from AbbVie, Eli Lilly, Leo Pharma, and Novartis Pharmaceuticals Corp; personal fees from Boehringer Ingelheim/Parexel, Bristol-Myers Squibb, Celgene, Dermavant, Janssen Pharmaceuticals Inc, Merck, Modernizing Medicine, Ortho Dermatologics, Pfizer Inc, Regeneron Pharmaceuticals, Sanofi Genzyme, Science 37 Inc, Genentech, GlaxoSmithKline, and Valeant; and grants from Dermira, Janssen-Ortho Inc, Kyowa Hakko Kirin, and UCB Pharma outside the submitted work. Dr Puig reported receiving grants and personal fees from AbbVie during the conduct of the study; grants and personal fees from Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Regeneron, Sanofi, Roche, and UCB outside the submitted work; and personal fees from Sandoz, Merck-Serono, MSD, Mylan, and Samsung-Bioepis. Dr Joshi is an employee AbbVie during the conduct of the study. Dr Skup is an employee AbbVie. Dr Williams is an of AbbVie. Dr Li reported receiving grants from AbbVie during the conduct of the study outside the submitted work. Dr Betts reported receiving consultancy fees from AbbVie Inc. during the conduct of the study. No other disclosures were reported.
Funding/Support: Design, study conduct, and financial support for the study were provided by AbbVie.
Role of the Funder/Sponsor: AbbVie participated in the interpretation of data, review, and approval of the abstract; all authors contributed to the development of the publication and maintained control over the final content.
Additional Contributions: Yan Wang, ScD, and Viviana Garcia-Horton, PhD, provided analytical support and Gloria DeWalt, PhD (Analysis Group Inc), provided editorial assistance. Analysis Group Inc received payment from AbbVie for participation in this research. Palvi Gupta, MPharm, Jatin Gupta, MPharm, and Rashi Patel, MPharm (DRG Abacus) provided support with literature search and study selection.
You currently have no searches saved.
You currently have no courses saved.