A recent meta-analysis published in British Journal of Dermatology reviewed the latest evidence on efficacy and tolerability of the available biologic agents for the treatment of moderate to severe plaque psoriasis. Mahlil et al reviewed 62 randomized controlled trials, with a total of 31,899 patients, with direct comparisons between biologic agents or with methotrexate or placebo. Their hierarchical cluster analysis revealed three clusters based on efficacy:
- Adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high short-term efficacy and tolerability
- Infliximab and ixekzumab had high short-term efficacy but lower tolerability than the previous cluster but higher than the third cluster
- Methotrexate, placebo, and etanercept had low efficacy with moderate tolerability
The researchers noted, however, that no one agent should be considered "best" due to the similar outcomes in short-term efficacy and tolerability in the first cluster. They also noted that the data should be interpreted in the context of long-term efficacy and effectiveness, safety, and costs.
Given the above evidence and your own clinical experience, which biologic class do you prescribe most often? Let us know in the poll below!
Mahil SK, Ezejimofor MC, Exton LS, et al. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta‐analysis. Br J Dermatol. Published online June 20, 2020. doi:10.1111/bjd.19325