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Network meta‐analyses of systemic treatments for psoriasis: a critical appraisal
Author(s) -
Ellis A.G.,
Flohr C.,
Drucker A.M.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17335
Subject(s) - medicine , ixekizumab , secukinumab , ustekinumab , adalimumab , psoriasis area and severity index , infliximab , etanercept , adverse effect , systematic review , psoriasis , randomized controlled trial , critical appraisal , clinical trial , intensive care medicine , quality of life (healthcare) , medline , dermatology , alternative medicine , psoriatic arthritis , disease , pathology , rheumatoid arthritis , nursing , political science , law
Summary Aim There are numerous systemic medications in use for psoriasis, with additional investigational agents being studied. However, head‐to‐head, randomized clinical trials are rare and cannot feasibly compare all treatments. A network meta‐analysis ( NMA ) synthesizes the available evidence to provide estimates for all pairwise comparisons. Here, we summarize and appraise two recent NMA s that assessed systemic therapies for moderate‐to‐severe psoriasis. Setting and design Two systematic reviews searched databases and the grey literature to identify relevant randomized clinical trials. Study participants The reviews mostly included trials that involved adults with moderate‐to‐severe psoriasis. One of the reviews also included two trials involving 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 biological agents along with new small‐molecule treatments 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% measured on the Psoriasis Area and Severity Index ( PASI 90) and serious adverse events. Outcomes Additional outcomes included quality of life, PASI 75, Physician's Global Assessment of 0/1 and any adverse event. Results Overall, both NMA s 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 that newer biologics targeting the interleukin ( IL )‐12/23 and IL ‐17 axes appear to be more effective than older biologics and oral agents. Conclusions Patients, clinicians and policy makers can use the relative efficacy assessments of NMA s to inform decision making regarding the clearance of psoriasis skin lesions at relevant time points and improvement in quality of life.