Background
Patients with moderate‐to‐severe psoriasis require long‐term treatment, yet few trials compare outcomes beyond a short‐term induction period. Quantitative comparisons of long‐term outcomes in patients with psoriasis are limited. To our knowledge, no network meta‐analysis (NMA) of such data has been performed.
Objective
To compare novel systemic therapies, both biologic and non‐biologic, approved for moderate‐to‐severe psoriasis by conducting a systematic review (SR) and NMA of Psoriasis Area and Severity Index (PASI) outcomes measured at or around 1 year.
Methods
An SR was conducted to identify studies reporting PASI 75, PASI 90 and PASI 100 responses. Feasibility of an NMA on maintenance phase endpoints was assessed and sources of heterogeneity considered. Data appropriate for analysis were modelled using a Bayesian multinomial likelihood model with probit link. Wherever possible, data corresponding to an intention‐to‐treat approach with non‐responder imputation were used.
Results
Twenty‐four studies reporting outcomes at 40–64 weeks were identified, but heterogeneity in study design allowed synthesis of only 17. Four 52‐week randomized controlled trials (RCTs) comprised the primary analysis, which found brodalumab was significantly more efficacious than secukinumab, ustekinumab and etanercept. Secukinumab was also more efficacious than ustekinumab and both outperformed etanercept. In a secondary analysis, evidence from 13 additional studies and 4 further therapies (adalimumab, apremilast, infliximab and ixekizumab) was included by comparing long‐term outcomes from active interventions to placebo outcomes extrapolated from induction. Results were consistent with the primary analysis: brodalumab was most effective, followed by ixekizumab and secukinumab, then ustekinumab, infliximab and adalimumab. Etanercept and apremilast had the lowest expected long‐term efficacy. Results were similar when studies with low prior exposure to biological therapies were excluded.
Conclusion
Results suggest that brodalumab is associated with a higher likelihood of sustained PASI response, including complete clearance, at week 52 than comparators. Further long‐term active‐comparator RCT data are required to better assess relative efficacy across therapies.
considered (V, 2018). RESULTS: A total of 10,777 patients were estimated to receive biologics or apremilast in the first model year. Increased penetration of apremilast resulted in an estimated reduction of the total budget by 28.6%, leading to costsavings of V31,606,416 over 5 years (V527,470,278 vs V495,863,863). Total costs per patient decreased by V2,374 over the same time period. The model yielded average annual cost-savings of 5.7% compared to the current treatment scenario. The sensitivity analyses confirmed the robustness of the model results.
A427were not limited to: wage/productivity losses, formal/informal care requirements, government financial support and out-of-pocket expenses. Statistical significance was assessed using Mann-Whitney U tests. Results: In total, 1030 patients and 427 accompanying informal caregivers were recruited. The majority of patients were receiving first-line therapy (70.5%); patients were largely receiving chemotherapy, regardless of line of therapy. Mean annual wage losses, productivity losses, unadjusted out-of-pocket costs and out-of-pocket costs adjusted for government financial support were
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