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Background: A comprehensive assessment of the risk-benefit profile of biologic agents in psoriasis is lacking. We conducted a network meta-analysis of randomized trials on biologic agents in psoriasis.\ud\udMethods: Trials on biologic agents in psoriasis (including psoriatic arthritis) were sought in several databases. Endpoints were ≥75% Reduction in the Psoriasis Area and Severity Index (PASI75), ≥20% improvement in the American College of Rheumatology core set of outcomes (ACR20), serious adverse events (SAE), and adverse events (AE) at the longest available non-cross-over follow-up. Random-effect methods were used to obtain pairwise and network pooled estimates.\ud\udResults: A total of 52 trials with 17,617 patients and 9 different biologic agents included, with 52% affected by psoriatic arthritis. After an average follow-up of 18 weeks, treatment with placebo was associated with a 5.9% (5.2%-6.6%) rate of PASI75, 17.4% (15.1%-19.6%) of ACR20, 2.4% (1.9%-2.8%) of SAE, and 51.8% (50.2%-53.4%) of AE. Several biologic agents provided higher PASI75 rates than placebo, with golimumab yielding the most favorable results (relative risk [RR]=14.02 [6.85-17.11]). Accordingly, several agents provided higher ACR20 rates than placebo, with infliximab yielding the most favorable results (RR=3.02 [1.67-4.55]). Overall, rates of SAE and AE were higher for several but not all biologic agents versus placebo, with golimumab being associated with the most favorable results for SAE (RR=0.40 [0.11-1.41]), and abatacept for AE (RR=1.00 [0.79-1.22]).\ud\udConclusions: Efficacy and safety of biologic agents for psoriasis differ, and clinicians should bear in mind these features to maximize safety and efficacy in the individual patient

Biologic Therapy for Psoriatic Arthritis or Moderate to Severe Plaque Psoriasis: Systematic Review with Pairwise and Network Meta-Analysis