IL-17A inhibitors superior to other immunomodulators in moderate-to-severe plaque psoriasis
Interleukin 17A (IL-17A) inhibitors show better efficacy than ustekinumab in achieving clearance in adults with moderate-to-severe plaque psoriasis, a recent study has shown. Additionally, IL-17A inhibitors are generally more effective than etanercept, adalimumab and apremilast.
The network meta-analysis showed the following targeted immunomodulators in order of increasing relative risk (demonstrating greater likelihood) of achieving a 75-percent improvement on the Psoriasis Area and Severity Index (PASI) relative to placebo: apremilast (6.2), etanercept (9.6), adalimumab (13.0), ustekinumab (14.0), secukinumab (15.4), infliximab (16.2), brodalumab (17.3) and ixekizumab (17.9).
Infliximab, brodalumab and ixekizumab were shown to be statistically superior to apremilast, etanercept, adalimumab and ustekinumab. Furthermore, data from head-to-head studies showed similar results.
A previous network-meta-analysis showed that ixekizumab, secukinumab, brodalumab, guselkumab, certolizumab and ustekinumab, as compared to placebo, were the best choices for achieving PASI 90 in patients with moderate-to-severe psoriasis based on moderate- to high-certainty evidence. [Cochrane Database Syst Rev 2017 Dec 22;12:CD01153
To assess the comparative effectiveness of targeted immunomodulators for adults with moderate-to-severe plaque psoriasis, the investigators conducted a systematic literature review of placebo-controlled and head-to-head randomized trials of eight targeted immunomodulators that evaluated clinical benefits or harm.
In addition, a network meta-analysis adjusted for placebo response was carried out to perform indirect comparisons between agents. A 75-percent improvement on the PASI was the primary outcome.
The present study was limited by mostly short-term evidence (covering 10–16 weeks) and by few direct comparisons, according to the investigators.