Short-Term Efficacy of Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: A Systematic Literature Review and an Enhanced Multinomial Network Meta-Analysis

Fahrbach, Kyle; Sarri, Grammati; Phillippo, David; Neupane, Binod; Martel, Samantha E.; Kiri, S.; Reich, Kristian

doi:10.1007/s13555-021-00602-z

Cited by 16 publications

(13 citation statements)

References 101 publications

(40 reference statements)

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“…In this study, we highlighted that the available biologic therapies for psoriasis are efficacious for paediatric psoriasis. Our study showed that there was a trend to better response to certain biological classes and in particular that anti-IL-17 agents seem to be superior to anti-TNF-alpha therapies in the treatment of paediatric psoriasis, consistent with their corresponding efficacy in adults ( Fahrbach et al, 2021 ; Sbidian et al, 2021 ). However, all the drugs were compared in a blinded, randomised comparison in the short term.…”

Section: Discussionsupporting

confidence: 75%

Efficacy of Systemic Biologic Drugs in Pediatric Psoriasis: Evidence From Five Selected Randomized Clinical Trials

et al. 2022

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Background: Psoriasis is a chronic, immune-mediated skin disease that may occur at any age. Prevalence in children ranges between 0.5 and 1.0% across Europe. Approximately 10–20% of paediatric psoriasis patients are moderate-to-severe in severity and may require the use of systemic therapy.Objective: Recently, newer targeted, systemic therapies have been licensed for treatment of moderate-to-severe paediatric psoriasis. The objective of this study was to evaluate the short-term efficacy of available antipsoriatic systemic drugs in children with a narrative synthesis of key efficacy from randomized clinical trials.Methods: A systematic review of literature was performed on Medline and embase databases and the Cochrane Central Register of Controlled Trials. Randomized clinical trials investigating the efficacy of treatments licensed by the US Food and Drug Administration and/or the European Medicines Agency for paediatric and adolescent psoriatic population were retrieved and analyzed. Data from this literature review was assessed in line with GRADE (grading of recommendations, assessment, development and evaluations). The short-term (12-16 weeks) clinical efficacy from baseline was evaluated according to the Psoriasis Area and Severity Index (PASI) 75 and 90 compared to baseline. Illustrative comparative risks, relative risk (RR) and the number needed to treat (NNT) for response on PASI 75 and PASI 90 were extracted.Results: A total of five relevant studies were identified on two TNF-alpha blockers (etanercept and adalimumab), the IL12/23 inhibitor ustekinumab and two IL-17 inhibitors (ixekizumab, secukinumab). Comparators were placebo (3 studies), placebo and etanercept (1 study) methotrexate (1 study). All examined drugs resulted efficacious. The probability to achieve PASI 75 and PASI 90 was higher for the IL-12/23 and IL-17 inhibitors. Overall, the anti-IL17s and the anti-IL12/23 antibodies showed a more favourable NNT for PASI 75, whereas IL-17 inhibitors for PASI 90.Conclusion: The approved biological therapies may be beneficial for the treatment of moderate to severe plaque psoriasis in children and adolescents. Since psoriasis is a chronic and often challenging condition with no definitive solution, systematic evaluations of long-term efficacy, drug survival and adverse effects may help careful, individualized, patient-centered clinical decision making.

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Section: Discussionsupporting

confidence: 75%

Efficacy of Systemic Biologic Drugs in Pediatric Psoriasis: Evidence From Five Selected Randomized Clinical Trials

et al. 2022

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“…This study employed the REZ model—an enhancement to the standard multinomial analysis model—to study the comparative efficacy of non-biologic and biologic interventions in achieving improvement in PASI outcomes [ 35 ]. The REZ model addresses the inherent drawbacks of both the binomial and standard multinomial models.…”

Section: Discussionmentioning

confidence: 99%

“…The enhanced REZ multinomial model simultaneously addresses the drawbacks of both the binomial and standard multinomial models by adding a random effects component that allows for variability in relative effects across PASI levels, while still ‘borrowing strength’ through modelling a mean effect between each threshold. Fahrbach et al [ 35 ] demonstrated that the REZ model was associated with considerably better model fit for both the FE versus RE in another NMA conducted in patients with moderate to severe PSO. A multinomial model was employed because of the advantage given by such a model of synthesizing data across dependent outcomes (e.g., PASI 50/75/90/100) simultaneously.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, because the standard multinomial model assumes that a relative treatment effect (i.e., probit difference) is identical for all PASI levels, we modified the model to allow the relative treatment effects to vary across PASI thresholds. This modification, introduced by Fahrbach et al in another NMA of moderate to severe PSO [ 35 ], added a random-effects (RE) component to the parameter z and is referred to below as the ‘REZ’ model. This addition models each treatments’ increase in difficulty to the next-highest PASI cut-off as varying around a common mean while the standard model assumes all treatments have exactly the same mean difficulty (in probit terms) in achieving a higher PASI cut-off.…”

Section: Methodsmentioning

confidence: 99%

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Efficacy of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: A Systematic Literature Review and a Network Meta-Analysis

Armstrong

Fahrbach

Augustin

et al. 2022

Dermatol Ther (Heidelb)

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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

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“…Following, psoriasis is increasingly being recognized as systemic inflammatory disorder. The recent development of systemic therapy options and biologics neutralize or inhibit these cytokines and have revolutionized the treatment of moderate to severe psoriasis [for systematic reviews and meta-analyses: ( 27 – 30 )].…”

Section: Introductionmentioning

confidence: 99%

Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode

et al. 2022

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ObjectiveTraumatic childhood experiences and psychosocial stress may predispose the evolvement of somatic diseases. Psoriasis is a multifactorial chronic inflammatory skin disease that often associates with current and past stress. Both may entail pathological alterations in major stress axes and a balance shift in the level of T helper type 1 (Th1) and 2 (Th2) cytokines, affecting the development and course of psoriasis. Until now, it is unclear whether traumatic stress experiences during the childhood or current stress are more frequent in psoriatic compared to skin-healthy individuals, and if they interact with treatment outcome.MethodIn a prospective cohort study, the impact of acute and early childhood stress on the course of dermatological treatment were studied in patients with moderate to severe psoriasis (PSO). Patients were examined before (T1) and about 3 months after (T2) the beginning of a new treatment episode. Assessments included clinical outcomes (Psoriasis Area and Severity Index—PASI, Structured Clinical Interview SCID-I) and patient-reported outcomes (PRO) (Childhood Trauma Questionnaire-CTQ, Perceived Stress Scale-PSS, itching/scratching, Dermatology Life Quality Index-DLQI, Hospital Anxiety and Depression Scale, Body Surface Area, Self-Administered PASI).ResultsN = 83 PSO patients (median age 53.7, IQR 37.8, 62.5) and n = 66 skin-healthy control subjects (HC) (median age 51.5, IQR 33.3, 59.2) participated. PSO had higher CTQ physical neglect than HC, as well as higher PRO levels. The positive impact of improved skin on the skin-related quality of life was moderated by the perceived stress. Acute stress at T1 had a positive effect both on the skin severity and the skin-related quality of life. CTQ total closely interacted with baseline psoriasis severity, and was associated with higher improvement from T1 to T2.ConclusionOne might tentatively conclude, that chronic psychosocial stressors like childhood maltreatment may predispose the manifestation of psoriasis. The latter may be amplified by acute psychological stressors. In addition, the present evidence suggests that systemic therapies work well in PSO, with childhood trauma and acute psychosocial stress. Both should therefore be routinely assessed and addressed in PSO.

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Short-Term Efficacy of Biologic Therapies in Moderate-to-Severe Plaque Psoriasis: A Systematic Literature Review and an Enhanced Multinomial Network Meta-Analysis

Cited by 16 publications

References 101 publications

Efficacy of Systemic Biologic Drugs in Pediatric Psoriasis: Evidence From Five Selected Randomized Clinical Trials

Efficacy of Systemic Biologic Drugs in Pediatric Psoriasis: Evidence From Five Selected Randomized Clinical Trials

Efficacy of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: A Systematic Literature Review and a Network Meta-Analysis

Childhood Trauma and Psychosocial Stress Affect Treatment Outcome in Patients With Psoriasis Starting a New Treatment Episode

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