Meta-Analyses Confirm Validity, Usefulness of Systemic Therapies for Psoriasis

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Researchers provide a summary and analysis of 2 recent network meta-analysis (NMA) studies that evaluated systemic therapies for moderate-to-severe psoriasis.

Findings from a study published in the British Journal of Dermatology that analyzed 2 previously published network meta-analyses (NMA) support the validity and usefulness of systemic therapies for moderate to severe psoriasis.

This study analyzed 2 previously published NMAs that assessed systemic therapies for moderate to severe psoriasis with the outcome of either “‘clear/nearly clear’ and withdrawals from adverse events” (ZJL Study) or “improvement of 90% or more on the Psoriasis Area and Severity Index (PASI 90) and serious adverse events” (ES study). Both NMAs performed comparative analyses on the efficacy and safety of systemic therapies (ie, biologics and methotrexate in the ZJL study or traditional systemics or new oral agents in the ES study) to treat moderate to severe psoriasis. The study populations included mostly adults.

The authors noted that both previously published studies are “of high quality and provide a comprehensive summary of the evidence base and treatment effects.”

They added that both studies used best practices for conducting and reporting the systematic reviews. Both studies also used the Cochrane risk of bias tool, wherein 10 of 38 total trials had similar ratings for all domains. Discrepancies in the validity and analysis sensitivity of the assessment tool and incongruities in the analysis of the “study-level data using NMA models with random-effects for the treatment parameters” were noted.

The authors also discussed the conditional nature in treatment rankings, which is dependent upon the included treatments for comparison, and cumulative rankings previously published. Finally, the authors highlighted the correct use of a random-effect NMA model to address heterogeneity but questioned the previous studies’ analyses for consistency.

The investigators identified the following as study limitations: the need for a longer time frame for outcomes assessment, the lack of testing of newly available agents since the publication of the previous 2 studies, and the lack of real-world data to improve generalizability. 

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Taken together, the authors noted the validity and usefulness of the results from both network meta-analyses in regard to “clearing of psoriasis skin lesions at relevant time-points and improvement in quality of life” for patients affected by moderate to severe psoriasis.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to original reference for a full list of authors’ disclosures.

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Ellis AG, Flohr C, Drucker AM. Network meta-analyses of systemic treatments for psoriasis: a critical appraisal [published online October 22, 2018]. Br J Dermatol. doi: 10.1111/bjd.17335