Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year

Abstract

Purpose: To compare PASI outcomes of approved biologics and apremilast after 1 year of treatment. Methods: A systematic review identified RCTs and long-term extensions reporting PASI 75, 90, and 100 responses in adults with moderate-to-severe psoriasis. Data for analysis were modeled using a Bayesian multinomial likelihood model with probit link. Results: Twenty-eight studies reporting PASI responses were included in the network meta-analysis. Differences in study design led to a stepwise approach to synthesis, consisting of two analyses. The primary analysis included nine RCTs investigating comparative efficacy at 1 year. Results indicated risankizumab, brodalumab, and guselkumab were the most effective therapies, followed by ixekizumab and secukinumab; all demonstrated superiority to ustekinumab and etanercept. The secondary analysis extended the primary analysis with 19 further studies comparing active interventions to placebo outcomes extrapolated from induction. The interventions generating the highest PASI response were the same as the primary analysis. These therapies were more effective than apremilast, ustekinumab, adalimumab, certolizumab, etanercept, and infliximab. Conclusions: This NMA demonstrated that evaluated IL-17 and IL-23 inhibitors outperformed other biological therapies after 1 year. Risankizumab had a higher probability of achieving PASI outcomes than all other biologics, except brodalumab and guselkumab, where no significant difference could be concluded.

Effectiveness and clinical predictors of drug survival in psoriasis patients receiving apremilast: A registry analysis

“… 8 However, little is known about the drug survival associated with apremilast (ie, the proportion of patients on apremilast treatment at certain time points), effectiveness, and safety in real-world patients. 9 , 10 , 11 , 12 , 13 , 14 Biologic treatments for psoriasis tend to perform more poorly in real-world settings than in clinical trials. Therefore, it is important to evaluate the long-term effectiveness and drug survival of small molecules such as apremilast.…”

Comparative Efficacy and Relative Ranking of Biologics and Oral Therapies for Moderate-to-Severe Plaque Psoriasis: A Network Meta-analysis

“…To date, few studies have attempted an NMA comparing the relative efficacy of treatments in the long term. Yasmeen et al [16] found that risankizumab, brodalumab, and guselkumab were associated with a higher probability of achieving a PASI response than other biologics, but did not detect statistically significant differences between the three treatments.…”

“…While several recent network meta-analyses (NMAs) have been conducted to compare the relative efficacy of treatments for moderate-tosevere plaque psoriasis, knowledge gaps still exist [12][13][14][15][16][17][18][19]. First, PASI 100 results were not available in some of the recent NMAs [13,15].…”

Cost per responder for risankizumab vs secukinumab in patients with moderate-to-severe plaque psoriasis in Italy

“…Al fine di esplorare il grado di incertezza dei risultati dell'analisi principale (analisi a 52 settimane), nonché di validarne la robustezza, è stata condotta un'analisi di sensibilità deterministica (31), focalizzata sulla variabile chiave dell'analisi, ovvero i dati di efficacia stimati dallo studio IMMerge (1). Sono stati, così, ricalcolati i risultati dell'analisi principale per risankizumab e secukinumab, sostituendo i valori di efficacia a 52 settimane (PASI 90 e 100) stimati dallo studio IMMerge (1) con quelli calcolati, sempre a 52 settimane, da due recenti Network Meta-Analysis (NMA) condotte con l'obiettivo di valutare l'efficacia dei trattamenti nella PP da moderata a grave, di cui la Tabella III sintetizza i principali risultati (32,33). Infine, dal momento che quello considerato nell'analisi potrebbe non riflettere l'attuale prezzo di cessione dei due farmaci alle strutture sanitarie, in quanto potrebbero essere praticati degli sconti confidenziali, è stata condotta un'analisi di scenario finalizzata a stimare l'impatto sul costo per responder di alcune ipotesi di sconto sul prezzo di risankizumab e secukinumab.…”