BackgroundBiologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs are used in patients with psoriatic arthritis (PsA), but few studies directly compare their clinical efficacy. In such situations, network meta-analysis (NMA) can inform evidence-based decision-making.ObjectiveTo evaluate the comparative efficacy and safety of approved bDMARDs in patients with PsA.MethodsBayesian NMA was conducted to compare the clinical efficacy of bDMARDs at weeks 12‒16 in bDMARD-naïve patients with PsA in terms of American College of Rheumatology (ACR) criteria, Psoriatic Arthritis Response Criteria (PsARC) and Psoriasis Area and Severity Index (PASI). Safety end points were evaluated in the overall mixed population of bDMARD-naive and bDMARD-experienced patients.ResultsFor ACR, all treatments except abatacept were statistically superior to placebo. Infliximab was most effective, followed by golimumab and etanercept, which were statistically superior to most other treatments. Ixekizumab 80 mg every 2 weeks (Q2W) was statistically superior to abatacept subcutaneous, apremilast and both regimens of ustekinumab; similar findings were observed for ixekizumab 80 mg Q4W. For PsARC response, ixekizumab did not significantly differ from other therapies, except for golimumab, infliximab and etanercept, which were superior to most other agents including ixekizumab. For PASI response, infliximab was numerically most effective, but was not statistically superior to ixekizumab, which was the next best performing agent. Analysis of safety end points identified few differences between treatments.ConclusionOur NMA confirms the efficacy and acceptable safety profile of bDMARDs in patients with active PsA. There were generally few statistically significant differences between most treatments.

Introduction: Biologic treatments are increasingly being used in the management of moderate to severe plaque psoriasis (PSO). Bimekizumab is a selective inhibitor of both interleukin (IL)-17A and IL-17F approved for the treatment of moderate to severe PSO. Although bimekizumab trials provide comparisons to secukinumab, adalimumab and ustekinumab, there are no further head-to-head comparisons of bimekizumab to other biologics. This network meta-analysis (NMA) aimed to compare the short-term efficacy of bimekizumab versus other biologic systemic therapies for moderate to severe PSO. Methods: A systematic literature review was conducted to identify randomised controlled trials (RCTs) in patients with moderate to severe PSO. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Database of Systematic Reviews and PsycINFO were searched on July 1, 2020. An enhanced multinomial Bayesian NMA model was used to evaluate the comparative efficacy in 50%, 75%, 90% and 100% improvement from baseline Psoriasis Area

Objectives: Graft-versus-host disease (GVHD) is a severe complication of allogenic stem cell transplantation. Preliminary data suggest the potential role of ruxolitinib as a new treatment option in patients with corticosteroid-refractory GVHD. The aim of the present study was to explore the effectiveness and safety of ruxolitinib as a salvage therapy in this population. MethOds: A single-center, retrospective, observational study was carried out. Inclusion criteria: all patients with corticosteroidrefractory GVHD treated with ruxolitinib until June 2016. Collected variables: age, sex, underlying disease, GVHD location, type (acute or chronic) and grade, previous therapies, Eastern Cooperative Oncology Group (ECOG) performance status at baseline, daily dose of ruxolitinib, treatment response and grade ≥ 3 adverse events (AE). Data sources: pharmacy information system and clinical charts review. Results: 13 patients met the inclusion criteria. 46% were male, with a median age of 46 years (range:32-51). The majority of patients (77%) had an ECOG performance status = 1. The most frequent underlying condition was myeloid acute leukemia. Most of the patients (77%) had more than one part of the body affected, being the most affected the cutaneous and gastrointestinal locations. GVHD was chronic in 62% of patients, and 54% had grade ≥ 3 GVHD. The median number of previous GVHD-therapies was 3 (range: 3-5). The most frequency therapies were corticosteroids, inmmunosuppression therapies with tacrolimus and rapamycin, and photopheresis. The median daily dose of ruxolitib was 20 (range: 5-25) mg. The overall response rate was 77% (complete response: 23%, partial response: 54%). Esophageal affectation in one patient was the only AE ≥ 3 recorded. cOnclusiOns: Ruxolitinib appears to be an effective and safe treatment option for patients with GVHD who are refractory to corticosteroids and other available therapies. Randomized control trials are needed to confirm these promising results.

Introduction: Many targeted, systemic therapies have been developed for treatment of moderate-to-severe psoriasis (PsO). A network meta-analysis (NMA) allows for comparison between treatments not directly compared in randomized controlled trials (RCT). This study's objective was to compare the short-term (10-16 weeks) clinical efficacy according to the Psoriasis Area and Severity Index (PASI) among approved biologic treatments for moderate-tosevere PsO using a novel (enhanced) NMA model. Methods: A systematic literature review (SLR) of RCTs for patients with moderate-to-severe PsO was conducted. English publications in MED-LINE, Embase, and The Cochrane Library up to March 2019 were searched. An enhanced multinomial Bayesian NMA was performed to simultaneously adjust for baseline risk and utilize the conditional nature of the PASI (50, 75, 90, and 100) levels. The model relaxes typical constraints that all treatments must have the same ranks across PASI levels. Results: The SLR resulted in 319 relevant publications, of which 72 publications from 73 RCTs reporting 10-to 16-week data for at least one PASI response level (30,314 total patients) were included. Interleukin (IL) inhibitors (risankizumab, ixekizumab, brodalumab, secukinumab, and guselkumab) were the best performing treatments for achieving all PASI levels. Etanercept was outperformed by the other subcutaneous tumor necrosis factor a inhibitors. Application of an enhanced NMA model that allowed treatment rankings to differ by PASI level tested the robustness of results of previous NMAs in PsO. Conclusion:The results of this model confirmed that IL inhibitors are likely the best short-term treatment choices for improving all PASI levels.

First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.