Network meta-analyses of systemic treatments for psoriasis: a critical appraisal.
Authors of this article are:
Ellis AG, Flohr C, Drucker AM.
A summary of the article is shown below:
AIM: There are numerous systemic medications in use for psoriasis, with additional investigational agents being studied. Head-to-head, randomised clinical trials are, however, rare and cannot feasibly compare all treatments. A network meta-analysis (NMA) synthesises the available evidence to provide estimates for all pairwise comparisons. We summarise and appraise two recent NMAs assessing systemic therapies for moderate-to-severe psoriasis.SETTING AND DESIGN: Two systematic reviews searched databases and the grey literature to identify relevant randomised clinical trials.STUDY PARTICIPANTS: The reviews mostly included trials of adults with moderate-to-severe psoriasis. One of the reviews also included two trials of children.STUDY EXPOSURE: Interventions common to both reviews include adalimumab, etanercept, infliximab, ustekinumab, ixekizumab, secukinumab, and methotrexate. One of the reviews included additional interventions, primarily other biologic agents as well as new small molecule and systemic conventional treatments.PRIMARY OUTCOMES: One review focused on ‘clear/nearly clear’ and withdrawals from adverse events as study outcomes, while the second review focused on improvement of 90% or more on the Psoriasis Area and Severity Index (PASI 90) and serious adverse events.OUTCOMES: Additional outcomes included quality of life, PASI 75, 0/1 PGA, and any adverse event.RESULTS: Overall, both NMAs are of high quality and provide a comprehensive summary of the evidence base and treatment effects. Results, in terms of both estimates and rankings, suggest newer biologics targeting the interleukin-12/23 and -17 axes appear more effective than older biologics and oral agents.CONCLUSIONS: Patients, clinicians, and policy-makers can use the relative efficacy assessments of NMAs to inform decision-making with regards to clearing of psoriasis skin lesions at relevant time points and improvement in quality of life. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
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