3 research outputs found
Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis
Background
The rapid expansion of psoriasis biologics has led to an urgent need to understand their relative efficacy and tolerability to inform treatment decisions better and, specifically, to inform guideline development.
Objectives
To update a 2017 metaâanalysis on the comparative efficacy and tolerability of biologic treatments for psoriasis.
Methods
We searched the MEDLINE, PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs), published up to 7 September 2018, of 11 licensed, NICEâapproved biologics targeting tumour necrosis factor (adalimumab, etanercept, infliximab, certolizumab pegol), interleukin (IL)â12/ILâ23p40 (ustekinumab), ILâ17A (secukinumab, ixekizumab), ILâ17RA (brodalumab) and ILâ23p19 (guselkumab, tildrakizumab, risankizumab). A frequentist network metaâanalysis ascertained direct or indirect evidence comparing biologics with one another, methotrexate or placebo. This was combined with hierarchical cluster analyses to consider efficacy (â„ 90% improvement in Psoriasis Area and Severity Index (PASI 90) or Physicianâs Global Assessment 0 or 1; PASI 75; Dermatology Life Quality Index improvement) and tolerability (drug withdrawal due to adverse events) outcomes at 10â16 weeks, followed by assessments of study quality, heterogeneity and inconsistency.
Results
We identified 62 RCTs presenting data on direct comparisons (31 899 participants). All biologics were efficacious compared with placebo or methotrexate at 10â16 weeks. Hierarchical cluster analyses revealed that adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high shortâterm efficacy and tolerability. Infliximab and ixekizumab clustered together, with high shortâterm efficacy but relatively lower tolerability than the other agents, although the number of drug withdrawal events across the network was low, so these findings should be treated with caution.
Conclusions
Using our methodology we found that most biologics cluster together with respect to shortâterm efficacy and tolerability, and we did not identify any single agent as âbestâ. These data need to be interpreted in the context of longerâterm efficacy, effectiveness data, safety, posology and drug acquisition costs when making treatment decisions.</p
Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis
Background
The rapid expansion of psoriasis biologics has led to an urgent need to understand their relative efficacy and tolerability to inform treatment decisions better and, specifically, to inform guideline development.
Objectives
To update a 2017 metaâanalysis on the comparative efficacy and tolerability of biologic treatments for psoriasis.
Methods
We searched the MEDLINE, PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs), published up to 7 September 2018, of 11 licensed, NICEâapproved biologics targeting tumour necrosis factor (adalimumab, etanercept, infliximab, certolizumab pegol), interleukin (IL)â12/ILâ23p40 (ustekinumab), ILâ17A (secukinumab, ixekizumab), ILâ17RA (brodalumab) and ILâ23p19 (guselkumab, tildrakizumab, risankizumab). A frequentist network metaâanalysis ascertained direct or indirect evidence comparing biologics with one another, methotrexate or placebo. This was combined with hierarchical cluster analyses to consider efficacy (â„ 90% improvement in Psoriasis Area and Severity Index (PASI 90) or Physicianâs Global Assessment 0 or 1; PASI 75; Dermatology Life Quality Index improvement) and tolerability (drug withdrawal due to adverse events) outcomes at 10â16 weeks, followed by assessments of study quality, heterogeneity and inconsistency.
Results
We identified 62 RCTs presenting data on direct comparisons (31 899 participants). All biologics were efficacious compared with placebo or methotrexate at 10â16 weeks. Hierarchical cluster analyses revealed that adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high shortâterm efficacy and tolerability. Infliximab and ixekizumab clustered together, with high shortâterm efficacy but relatively lower tolerability than the other agents, although the number of drug withdrawal events across the network was low, so these findings should be treated with caution.
Conclusions
Using our methodology we found that most biologics cluster together with respect to shortâterm efficacy and tolerability, and we did not identify any single agent as âbestâ. These data need to be interpreted in the context of longerâterm efficacy, effectiveness data, safety, posology and drug acquisition costs when making treatment decisions.</p