Abstract
Background: The comparative effectiveness of available targeted immunomodulators for moderate-to-severe psoriasis has not been evaluated. Objective: To evaluate the comparative effectiveness of targeted immunomodulators for adults with moderate-to-severe plaque psoriasis. Methods: Systematic literature review of placebo-controlled and head-to-head randomized trials of 8 targeted immunomodulators that evaluated clinical benefits or harm. The primary outcome was a 75% improvement on the Psoriasis Area and Severity Index. We also conducted a network meta-analysis adjusted for placebo response to perform indirect comparisons between agents. Results: In the network meta-analysis, the targeted immunomodulators ordered by increasing relative risk (demonstrating greater likelihood) of achieving a 75% improvement on the Psoriasis Area and Severity Index relative to placebo were as follows: 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). Ixekizumab, brodalumab, and infliximab were all statistically superior to ustekinumab, adalimumab, etanercept, and apremilast; results were similar to those of head-to-head studies where data were available. Limitations: Much of the evidence is short-term (covering 10-16 weeks); limited direct comparisons. Conclusions: The interleukin 17A inhibitors are more effective in achieving clearance than ustekinumab, and they are generally more effective than etanercept, adalimumab, and apremilast.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 135-144.e7 |
| Journal | Journal of the American Academy of Dermatology |
| Volume | 79 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2018 |
Funding
Funding sources: Supported by the Institute for Clinical and Economic Review. (ICER). For a summary of ICER funding, please see https://icer-review.org/about/support/ . Disclosure: Dr Linder owns stock in Amgen, Biogen, and Eli Lily and has contingent value rights in Sanofi Genzyme (related to alemtuzumab for multiple sclerosis). In the past 3 years, Dr Linder has received grant support from Astellas Pharma for research on overactive bladder and grant support from AstraZeneca for research on Clintrex and screening for dementia, and he has received an honorarium from the Society of Healthcare Epidemiology of America as part of the Society of Healthcare Epidemiology of America Antimicrobial Stewardship Research Workshop Planning Committee, an educational activity supported by Merck. Drs Pearson and Ollendorf and Ms Segel are employees of the Institute for Clinical and Economic Review, an independent organization that evaluates the evidence on the value of health care interventions, that is funded by grants from the Laura and John Arnold Foundation, Blue Shield of California Foundation, and the California HealthCare Foundation. No other conflicts of interest were disclosed.
Keywords
- adalimumab
- apremilast
- brodalumab
- etanercept
- infliximab
- ixekizumab
- network meta-analysis
- plaque psoriasis
- secukinumab
- ustekinumab
ASJC Scopus subject areas
- Dermatology