Speed of Response in Biologic Treatments for Moderate-to-Severe Plaque Psoriasis: Bayesian Network Meta-Analysis.

Abstract

Background: Psoriasis is a chronic inflammatory condition affecting approximately 3% of adults in the United States (US). While biologic therapies have transformed treatment for psoriasis, the speed and efficacy of response vary among biologics. This network meta-analysis (NMA) evaluates the efficacy and speed of response of interleukin (IL)-17 and IL-23, and tumor necrosis factor-alpha (TNF-alpha) inhibitors during the first 8 weeks of treating moderate-to-severe plaque psoriasis.

Methods: This Bayesian NMA used data from 53 phase 2b and 3 randomized controlled trials (RCTs). Efficacy was measured by Psoriasis Area and Severity Index (PASI) 75, PASI 90, and PASI 100 (≥75%, ≥90%, and 100% reduction in PASI score) at weeks 4 and 8. Absolute differences (absolute response minus placebo; AD) were calculated using a random-effects model.

Results: IL-17 inhibitors, specifically brodalumab, bimekizumab, and ixekizumab, had the highest AD in PASI 75, PASI 90, and PASI 100 at week 4 and week 8.

Discussion/conclusion: IL-17 inhibitors, specifically bimekizumab, brodalumab, and ixekizumab, had a higher percentage of patients (measured as absolute difference in this study), achieving PASI 75, PASI 90, and PASI 100 at week 4 and week 8. However, there was no significant difference in absolute difference for the same endpoints and time points for patients treated with brodalumab, bimekizumab, and ixekizumab. IL-23 inhibitors, while effective, exhibited a slower onset; TNF-alpha inhibitors, except infliximab, generally showed slower responses. Indirect comparisons and differences in study design and populations may limit the generalizability of the results.  .