Review finds treatments associated with highest PASI response rates in plaque psoriasis
Several novel treatments for moderate to severe plaque psoriasis were associated with the highest Psoriasis Area and Severity Index response rates, according to a comprehensive assessment of efficacy published in JAMA Dermatology.
“Results from this study suggest that brodalumab, guselkumab, ixekizumab and risankizumab-rzaa had significantly higher PASI response rates than adalimumab, apremilast, certolizumab pegol, dimethyl fumarate, etanercept, tildrakizumab-asmn and ustekinumab at the end of the primary response period,” April W. Armstrong, MD, MPH, of the department of dermatology at Keck School of Medicine at the University of Southern California, Los Angeles, and colleagues wrote.
A systematic literature review and meta-analyses of 60 short-term and 22 long-term trials were conducted to identify randomized clinical trials of plaque psoriasis treatments using the Embase, Medline and Cochrane Central Register databases. Each evaluated trial was licensed by the FDA and the European Medicines Agency for adults with moderate to severe psoriasis. Trials included data on PASI assessment of 75%, 90% and 100% reductions for short-term efficacy (10 to 16 weeks) and long-term efficacy (44 to 60 weeks) from baseline.
Among all the drugs evaluated, the highest PASI 75, 90 and 100 response rates at 10 to 16 weeks for short-term efficacy were risankizumab-rzaa (89.2%, 71.6%, 40.4%), ixekizumab (88.8%, 70.8%, 39.5%), brodalumab (88.7%, 70.6%, 39.2%) and guselkumab (86.8%, 67.3%, 35.7%).
Highest PASI 75, 90 and 100 response rates at 44 to 60 weeks for long-term efficacy were for risankizumab-rzaa (90.1%, 79.4%, 56.2%), guselkumab (88.2%, 76.5%, 47.4%), ixekizumab (85%, 73.9%, 54.3%) and brodalumab (80%, 74%, 54.5%).
“In the absence of head-to-head randomized clinical trials of treatments for moderate to severe plaque psoriasis, this study provides what we believe to be a comprehensive assessment of the comparative short-term and long-term efficacy among several novel treatments,” the researchers wrote.
Meta-analyses have the ability to standardize effects of drugs across numerous trials so that researchers can make comparisons to reflect overall efficacy of these drugs.
“From this perspective, meta-analyses are a shortcut to a true comparative effectiveness study, perhaps abrogating the need for head-to-head trials,” Bruce Strober, MD, PhD, of the department of dermatology at Yale University School of Medicine and Central Connecticut Dermatology Research, and Kenneth B. Gordon, MD, of the Medical College of Wisconsin, Milwaukee, wrote in an accompanying editorial. “However, when assessing meta-analyses, one must identify potential pitfalls that can result in bias.”
These include entry criteria, differences in patient populations, location of study sites, body weight of enrolled patients, presence or absence of a placebo, and duration of the comparison period.
“The raw rankings of efficacy as determined by the Armstrong et al [network meta-analysis] and other recently published [network meta-analyses] offer a valuable starting point from which to initiate discussions with patients and improve shared decision-making related to choosing the most appropriate psoriasis treatment,” Strober and Gordon wrote. – by Erin T. Welsh
Disclosures: Armstrong reports she receives grants and personal fees from AbbVie, Eli Lilly, Leo Pharma and Novartis; personal fees from Boehringer Ingelheim/Parexel, Bristol-Myers Squibb, Celgene, Dermavant, Janssen Pharmaceuticals, Merck, Modernizing Medicine,
Ortho Dermatologics, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, Science 37,
Genentech, GlaxoSmithKline and Valeant; and grants from Dermira, Janssen-Ortho, Kyowa Hakko Kirin and UCB Pharma. Strober reports he receives personal fees from AbbVie, Almirall, Amgen, Arena, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Dermavant, Dermira, Janssen, Leo, Lilly, Kyowa Hakko Kirin, Medac, Meiji Seika, Novartis, Pfizer, GlaxoSmithKline, UCB, Sun, Ortho Dermatologics, Regeron and Sanofi-Genzyme; and serves as co-scientific director of the Corrona Psoriasis Registry, for which he receives consultancy fees. Please see the reports for all other authors’ relevant financial disclosures.