Quantitative evaluation of biologic therapy options for psoriasis: a systematic review and network meta-analysis

Jabbar-Lopez, Z. K. et al. (2017) Quantitative evaluation of biologic therapy options for psoriasis: a systematic review and network meta-analysis. Journal of Investigative Dermatology, 137(8), pp. 1646-1654. (doi: 10.1016/j.jid.2017.04.009) (PMID:28457908) (PMCID:PMC5519491)

Abstract

Multiple biologic treatments are licensed for psoriasis. The lack of head-to-head randomized controlled trials makes choosing between them difficult for patients, clinicians, and guideline developers. To establish their relative efficacy and tolerability, we searched MEDLINE, PubMed, Embase, and Cochrane for randomized controlled trials of licensed biologic treatments for skin psoriasis. We performed a network meta-analysis to identify direct and indirect evidence comparing biologics with one another, methotrexate, or placebo. We combined this with hierarchical cluster analysis to consider multiple outcomes related to efficacy and tolerability in combination for each treatment. Study quality, heterogeneity, and inconsistency were evaluated. Direct comparisons from 41 randomized controlled trials (20,561 participants) were included. All included biologics were efficacious compared with placebo or methotrexate at 3–4 months. Overall, cluster analysis showed adalimumab, secukinumab, and ustekinumab were comparable in terms of high efficacy and tolerability. Ixekizumab and infliximab were differentiated by very high efficacy but poorer tolerability. The lack of longer term controlled data limited our analysis to short-term outcomes. Trial performance may not equate to real-world performance, and so results need to be considered alongside real-world, long-term safety and effectiveness data. These data suggest that it is possible to discriminate between biologics to inform clinical practice and decision making (PROSPERO 2015:CRD42015017538).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Burden, Professor David
• Authors: Jabbar-Lopez, Z. K., Yiu, Z. Z.N., Ward, V., Exton, L. S., Mohd Mustapa, M. F., Samarasekera, E., Burden, A. D., Murphy, R., Owen, C. M., Parslew, R., Venning, V., Warren, R. B., and Smith, C. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Journal of Investigative Dermatology
• Publisher: Elsevier
• ISSN: 0022-202X
• ISSN (Online): 1523-1747
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Journal of Investigative Dermatology 137(8):1646-1654
• Publisher Policy: Reproduced under a Creative Commons licence