Comparative Efficacy of Biologic Therapies for Plaque Psoriasis: A Network Meta-Analysis

Background: Biologics have significantly improved outcomes for patients with psoriasis. However, with multiple agents targeting different immunological pathways, comparative efficacy data is essential to guide optimal treatment selection. Objective: To compare the efficacy of eight biologic therapies in achieving Psoriasis Area Severity Index 75 response in patients with plaque psoriasis. Methods: A systematic review and network meta-analysis (NMA) was conducted per PRISMA-NMA guidelines. Open-access randomized controlled trials (RCTs) involving adults with plaque psoriasis treated with adalimumab, ustekinumab, secukinumab, ixekizumab, bimekizumab, guselkumab, risankizumab, or tildrakizumab were included. Psoriasis Area Severity Index 75 at approximately 12 weeks was the primary outcome. A frequentist random-effects model was used Results: 29 RCTs (13923 participants) were included. 8 biologics were analyzed. All agents outperformed placebo. 11 of the combinations out of 325 had significant inconsistency. Transitivity assumptions based on randomization and study design were not addressed. Ixekizumab 80mg was the best treatment compared to placebo and all other biologics, while increasing dose of all drugs was not always associated with increasing efficacy except in the cases of Ustekinumab