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Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-analysis.
JAMA Dermatology ( IF 11.5 ) Pub Date : 2020-02-05 , DOI: 10.1001/jamadermatol.2019.4029 April W Armstrong 1 , Luis Puig 2 , Avani Joshi 3 , Martha Skup 3 , David Williams 3 , Junlong Li 4 , Keith A Betts 5 , Matthias Augustin 6
JAMA Dermatology ( IF 11.5 ) Pub Date : 2020-02-05 , DOI: 10.1001/jamadermatol.2019.4029 April W Armstrong 1 , Luis Puig 2 , Avani Joshi 3 , Martha Skup 3 , David Williams 3 , Junlong Li 4 , Keith A Betts 5 , Matthias Augustin 6
Affiliation
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Importance
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.
Objective
To estimate the relative short-term and long-term efficacy of biologics and oral agents for the treatment of moderate to severe psoriasis.
Data Sources
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.
Study Selection
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.
Results
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.
中文翻译：
斑块状牛皮癣的生物制剂和口服制剂比较：一项荟萃分析。
重要性对于中度至重度牛皮癣的新疗法的临床益处已得到充分确立，但不同疗法对患者的反应存在很大差异。在缺乏头对头随机试验的情况下，需要综合多项研究的荟萃分析来评估银屑病治疗之间的相对疗效。目的评估生物制剂和口服药物治疗中至重度牛皮癣的相对短期和长期疗效。数据来源2017年12月4日进行了系统的文献综述，并于2018年9月17日进行了更新。其中包括Embase，MEDLINE和Cochrane Central Register数据库。研究选择阶段2、3，或4项由美国食品药品监督管理局（FDA）和欧洲药品管理局（European Medicines Agency）批准的针对中度至重度银屑病成人的治疗的随机临床试验，其银屑病面积和严重性指数评估数据分别降低了75％，90％和100％（PASI 75 ，90和100）距基线10至16周（短期疗效）或44至60周（长期疗效）。数据提取和综合数据是根据“系统评价和荟萃分析的首选报告项目”提取的。进行了贝叶斯网络荟萃分析，以估计短期的PASI反应率。为了说明各试验之间的差异，实施了针对参考臂反应进行调整的序数模型。长期PASI率是通过传统的荟萃分析估算的。主要结果和衡量指标PASI 75、90，从基线开始的10到16周和44到60周的响应率为100。结果纳入了符合所有入选标准的60项试验。在第10周到第16周，risankizumab-rzaa（71.6％; 95％可信区间[CrI]，67.5％-75.4％），brodalumab（70.8％; 95％CrI，66.8％-74.6％）的PASI 90发生率最高。 ），依克珠单抗（70.6％; 95％CrI，66.8％-74.6％）和古塞单抗（67.3％; 62.5％-71.9％）在第44至60周时，PASI 90发生率最高的治疗方法是利桑基单抗-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％）和依克珠单抗（73.9％; 95％CI，69.9％-77.5％）。短期和长期PASI 75和100响应的结果一致。结论与相关性本研究评估了中度至重度斑块状牛皮癣的治疗效果。荟萃分析表明，在短期和长期治疗中，布罗达单抗，guselkumab，依克珠单抗和利桑木单抗-rzaa与最高的PASI反应率相关。
更新日期：2020-03-12
中文翻译：
斑块状牛皮癣的生物制剂和口服制剂比较：一项荟萃分析。
重要性对于中度至重度牛皮癣的新疗法的临床益处已得到充分确立，但不同疗法对患者的反应存在很大差异。在缺乏头对头随机试验的情况下，需要综合多项研究的荟萃分析来评估银屑病治疗之间的相对疗效。目的评估生物制剂和口服药物治疗中至重度牛皮癣的相对短期和长期疗效。数据来源2017年12月4日进行了系统的文献综述，并于2018年9月17日进行了更新。其中包括Embase，MEDLINE和Cochrane Central Register数据库。研究选择阶段2、3，或4项由美国食品药品监督管理局（FDA）和欧洲药品管理局（European Medicines Agency）批准的针对中度至重度银屑病成人的治疗的随机临床试验，其银屑病面积和严重性指数评估数据分别降低了75％，90％和100％（PASI 75 ，90和100）距基线10至16周（短期疗效）或44至60周（长期疗效）。数据提取和综合数据是根据“系统评价和荟萃分析的首选报告项目”提取的。进行了贝叶斯网络荟萃分析，以估计短期的PASI反应率。为了说明各试验之间的差异，实施了针对参考臂反应进行调整的序数模型。长期PASI率是通过传统的荟萃分析估算的。主要结果和衡量指标PASI 75、90，从基线开始的10到16周和44到60周的响应率为100。结果纳入了符合所有入选标准的60项试验。在第10周到第16周，risankizumab-rzaa（71.6％; 95％可信区间[CrI]，67.5％-75.4％），brodalumab（70.8％; 95％CrI，66.8％-74.6％）的PASI 90发生率最高。 ），依克珠单抗（70.6％; 95％CrI，66.8％-74.6％）和古塞单抗（67.3％; 62.5％-71.9％）在第44至60周时，PASI 90发生率最高的治疗方法是利桑基单抗-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％）和依克珠单抗（73.9％; 95％CI，69.9％-77.5％）。短期和长期PASI 75和100响应的结果一致。结论与相关性本研究评估了中度至重度斑块状牛皮癣的治疗效果。荟萃分析表明，在短期和长期治疗中，布罗达单抗，guselkumab，依克珠单抗和利桑木单抗-rzaa与最高的PASI反应率相关。
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