TY - JOUR
T1 - Comparative effectiveness of targeted immunomodulators for the treatment of moderate-to-severe plaque psoriasis
T2 - A systematic review and network meta-analysis
AU - Loos, Anne M.
AU - Liu, Shanshan
AU - Segel, Celia
AU - Ollendorf, Daniel A.
AU - Pearson, Steven D.
AU - Linder, Jeffrey A.
N1 - Funding Information:
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/ .
Funding Information:
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.
Publisher Copyright:
© 2018 American Academy of Dermatology, Inc.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/7
Y1 - 2018/7
N2 - 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.
AB - 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.
KW - adalimumab
KW - apremilast
KW - brodalumab
KW - etanercept
KW - infliximab
KW - ixekizumab
KW - network meta-analysis
KW - plaque psoriasis
KW - secukinumab
KW - ustekinumab
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U2 - 10.1016/j.jaad.2018.02.027
DO - 10.1016/j.jaad.2018.02.027
M3 - Review article
C2 - 29438757
AN - SCOPUS:85045344978
VL - 79
SP - 135-144.e7
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
SN - 0190-9622
IS - 1
ER -