The Most Effective Biologic Agents in the Treatment of Psoriasis

In using biologic agents for the treatment of psoriasis, the highest clinical benefits over 52 weeks for complete skin clearance were observed in ixekizumab, risankizumab, and brodalumab, according to study data published in Dermatology and Therapy.

A systematic literature search identified published phase 3 randomized clinical trial data of biologic agents prescribed for psoriasis. In all, 14 published studies of 18 clinical trials were included from which to extract data. For each study, study duration, baseline PASI, and the response rates for PASI 90/100 at the last point in the study through week 52 were included. The studies were compared and analyzed using network meta-analysis, which uses common comparisons to normalize differences between studies.

The studies were used to compare the cumulative clinical benefits of treatment of biologic agents over 1 year. The comparisons were based on the area under the curve (AUC) for Psoriasis Area and Severity Index PASI 100 and PASI 90 responses in patients with moderate to severe psoriasis, using a network meta-analysis. For complete skin clearance, the highest cumulative clinical benefits over 52 weeks were exhibited by ixekizumab, risankizumab, and brodalumab. For almost-complete skin clearance, the highest cumulative benefits were exhibited for risankizumab, ixekizumab, and brodalumab. TNF inhibitors had the lowest cumulative benefits over a year of treatment.

Limitations to this study include the diversity in patient characteristics which can introduce bias in the comparisons; missing data, and studies that only reported response rates at limited time points. This analysis also only included randomized controlled studies and not real-world data.

Researchers concluded that, “this study provides clinically meaningful and relevant comparative data on biologics that reflects a combined measurement of therapeutic onset and magnitude of sustained skin clearance over time, and should better assist clinicians in their treatment choices for patients with moderate-to-severe psoriasis.”

Reference

Blauvelt A, Gooderham M, Griffiths C, et al. Cumulative clinical benefits of biologics in the treatment of patients with moderate-to-severe psoriasis over 1 Year: a network meta-analysis. Dermatol Ther. February 23, 2022. doi:10.1007/s13555-022-00690-5