Background

The comparative effectiveness of available targeted immunomodulators for moderate-to-severe psoriasis has not been evaluated.

Objective

To evaluate the comparative effectiveness of targeted immunomodulators for adults with moderate-to-severe plaque psoriasis.

Methods

Systematic literature review of placebo-controlled and head-to-head randomized trials of 8 targeted immunomodulators that evaluated clinical benefits or harm. The primary outcome was a 75% improvement on the Psoriasis Area and Severity Index. We also conducted a network meta-analysis adjusted for placebo response to perform indirect comparisons between agents.

Results

In the network meta-analysis, the targeted immunomodulators ordered by increasing relative risk (demonstrating greater likelihood) of achieving a 75% improvement on the Psoriasis Area and Severity Index relative to placebo were as follows: apremilast (6.2), etanercept (9.6), adalimumab (13.0), ustekinumab (14.0), secukinumab (15.4), infliximab (16.2), brodalumab (17.3), and ixekizumab (17.9). Ixekizumab, brodalumab, and infliximab were all statistically superior to ustekinumab, adalimumab, etanercept, and apremilast; results were similar to those of head-to-head studies where data were available.

Limitations

Much of the evidence is short-term (covering 10-16 weeks); limited direct comparisons.

Conclusions

The interleukin 17A inhibitors are more effective in achieving clearance than ustekinumab, and they are generally more effective than etanercept, adalimumab, and apremilast.

中文翻译：

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靶向免疫调节剂治疗中度至重度斑块状牛皮癣的比较效果：系统评价和网络荟萃分析

背景

尚未评估可利用的靶向免疫调节剂对中度至重度牛皮癣的相对有效性。

客观的

评估靶向免疫调节剂对中度至重度斑块状牛皮癣成人的比较有效性。

方法

系统评价了8项靶向免疫调节剂的安慰剂对照和头对头随机试验，这些试验评估了临床益处或危害。主要结果是牛皮癣面积和严重程度指数提高了75％。我们还进行了针对安慰剂反应进行调整的网络荟萃分析，以进行代理商之间的间接比较。

结果

在网络荟萃分析中，针对性免疫调节剂通过增加相对风险（表明更大的可能性）使银屑病面积和严重性指数相对于安慰剂提高了75％，分别是：apremilast（6.2），etanercept（9.6），阿达木单抗（13.0），ustekinumab（14.0），secukinumab（15.4），infliximab（16.2），brodalumab（17.3）和ixekizumab（17.9）。在统计学上，依克珠单抗，布罗达单抗和英夫利昔单抗均优于乌斯替单抗，阿达木单抗，依那西普和阿米司特。结果与有可用数据的头对头研究的结果相似。

局限性

许多证据是短期的（涵盖10至16周）；有限的直接比较。

结论

白介素17A抑制剂在清除方面比ustekinumab更有效，并且通常比etanercept，adalimumab和apremilast更有效。