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Psoriasis Treatment Meta-analysis Identifies Therapies With Highest Response Rates

A recent meta-analysis highlighted several biologics that were associated with higher short-term and long-term response rates. Risankizumab-rzaa (Skyrizi), brodalumab (Siliq), ixekizumab (Taltz), and guselkumab (Tremfya) were found to achieve and maintain Psoriasis Area and Severity Index (PASI) improvements of 75% or higher at weeks 10 to 16 and weeks 44 to 66 compared with other therapies, according to the findings of the study.1

“The clinical benefits of novel treatments for moderate to severe psoriasis are well established, but wide variations exist in patient response across different therapies,” the researchers said.

“In the absence of head-to-head randomized clinical trials of treatments for moderate to severe plaque psoriasis, this study provides what we believe to be a comprehensive assessment of the comparative short-term and long-term efficacy among several novel treatments,” they added.
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In the systematic review and meta-analysis, the researchers analyzed data from 60 clinical trials to compare the short-term and long-term efficacy of biologics and oral agents. Data was extracted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Main outcomes included PASI improvement of 75%, 90%, and 100% response rates at 10 to 16 weeks and at 44 to 60 weeks from baseline.

The researchers found that risankizumab-rzaa (71.6%; 95% credible interval [CrI], 67.5%-75.4%), had the highest PASI 90 rates at week 10 to 16, followed by 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, risankizumab-rzaa had the highest PASI 90 rates (79.4%, 95% CI, 75.5%-82.9%), followed by 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%), the researchers said.

These findings were consistent for short-term and long-term PASI 75 and 100 responses as well, they added.

In an accompanying editorial,2 Bruce Strober, MD, PhD, and Kenneth B. Gordon, MD, noted that there were several pitfalls for performing drug comparisons using meta-analyses, such as biases in the data used for analysis and the inability to evaluate long-term drug survival. According to Drs Strober and Gordon, “what is left to the reader is determining the clinical relevance of small distinctions between medications that result from these evaluations.”

They added, “the raw rankings of efficacy as determined by the Armstrong et al1 network meta-analyses and other recently published network meta-analyses offer a valuable starting point from which to initiate discussions with patients and improve shared decision making related to choosing the most appropriate psoriasis treatment.”

References

1. Armstrong AW, Puig L, Joshi A, et al. Comparison of biologics and oral treatments for plaque psoriasis: A meta-analysis [published online February 05, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4029

2. Strober B, Gordon KB. Comparative effectiveness studies for psoriasis—the methods matter [published online February 05, 2020]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.4025

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