Short-term efficacy and safety of new biological agents targeting the interleukin-23-T helper 17 pathway for moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis.
A new generation of biologics targeting the interleukin-23-T helper 17 pathway has been developed. This study aimed to assess the short-term effectiveness and safety of these new agents using a network meta-analysis. Twenty-seven randomized clinical trials (10 629 patients) were identified by a comprehensive systematic literature review (PROSPERO 2015: CRD42015025472). Quality of evidence was assessed following Cochrane-compliant rules and the Grading of Recommendations, Assessment, Development and Evaluations approach. Efficacy and safety outcomes at weeks 10-16 were compared using a random-effects network meta-analysis within a frequentist framework to estimate pooled odds ratios (ORs) of direct and indirect comparisons among the therapeutic options. There were six direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and indirect evidence. From the available evidence, infliximab 5 mg kg-1every 8 weeks [OR 118·89, 95% confidence interval (CI) 60·91-232·04] and secukinumab 300 mg every 4 weeks (OR 87·07, 95% CI 55·01-137·82) are shown to be among the most effective short-term treatments, but are ranked as the biologics most likely to produce any adverse event or an infectious adverse event, respectively. Ustekinumab 90 mg every 12 weeks, the third most efficacious treatment (OR 73·67, 95% CI 46·97-115·56), was the only agent that did not show increased risk of adverse events compared with placebo. Treatment recommendations should also consider long-term outcomes and costs.
Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.
F
F
Gómez-García
Department of Applied Economics, School of Economics, University of Granada, Granada, Spain.
D
D
Epstein
Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.|Department of Pharmacy, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.
B
B
Isla-Tejera
Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.
A
A
Lorente
Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.
A
A
Vélez García-Nieto
Department of Dermatology, Hospital Universitario Reina Sofía, Menendez Pidal Ave, 14004, Córdoba, Spain.|Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, Spain.
J
http://orcid.org/0000-0002-0286-4107
J
Ruano
D000328:Adult; D001685:Biological Factors / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053759:Interleukin-23 / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011565:Psoriasis / Q000188:drug therapy*; D058504:Th17 Cells / Q000187:drug effects*; D016896:Treatment Outcome
D001685:Biological Factors; D003879:Dermatologic Agents; D053759:Interleukin-23