title: Safety and Efficacy of Brodalumab for Moderate-to-Severe Plaque Psoriasis: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Psoriasis is an inflammatory skin disease that affects 2-3% of the worldwide population. The interleukin-17 cytokine family has been proven to play a central role in the pathogenesis of psoriasis. Brodalumab is a novel biologic agent that targets interleukin-17 molecules and their receptors. We aimed to evaluate the safety and efficacy of brodalumab as a therapeutic agent for moderate-to-severe psoriasis in a meta-analysis framework.
  
  
  METHODS
  A computer literature search of PubMed, OVID, Cochrane Central, EMBASE, EBSCO, Scopus, and Web of Science was conducted using relevant keywords. Data were extracted from eligible trials and analyzed using RevMan (Version 5.3 for windows) and OpenMeta [Analyst] software.
  
  
  RESULTS
  Six clinical trials (n = 4118 patients) were pooled in the final analysis. The pooled effect size favored brodalumab over placebo in terms of the Psoriasis Area and Severity Index (PASI) 75 [risk ratio (RR) = 12.61, 95% confidence interval (CI) 9.74-16.34], PASI 90 (RR = 28.72, 95% CI 18.34-44.98), and PASI 100 (RR = 61.23, 95% CI 25.48-147.17). Analysis of secondary outcomes showed that brodalumab was superior to placebo in terms of static physician's global assessment (RR = 32.53, 95% CI 13.80-76.69) and psoriasis symptoms inventory scores (RR = 14.70, 95% CI 8.38-25.78). Meta-regression analysis found a significant linear association between the brodalumab dose and the effect size on PASI and psoriasis symptoms inventory scores. The rate of overall adverse events was slightly higher in the brodalumab group (RR = 1.13, 95% CI 1.06-1.22); however, none of the individual adverse events were significantly higher in the brodalumab group, compared to the placebo group.
  
  
  CONCLUSIONS
  Brodalumab showed an acceptable safety profile and a robust efficacy in the treatment of moderate-to-severe plaque psoriasis. However, the current evidence is insufficient to confirm maintenance of these results in the long term; therefore, larger studies with longer follow-up periods are required.
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt. attiamohamed@azhar.edu.eg.|Faculty of Medicine, Al-Azhar University, Cairo, 31724, Egypt. attiamohamed@azhar.edu.eg.
authors.forename: Attia
authors.initials: A
authors.lastname: Attia
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Ain Shams University, Cairo, Egypt.|NovaMed Medical Research Association, Cairo, Egypt.
authors.forename: Abdelrahman Ibrahim
authors.initials: AI
authors.lastname: Abushouk
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Zagazig University, El Shrakia, Egypt.|Student Research Unit, Zagazig University, El Shrakia, Egypt.
authors.forename: Hussien
authors.initials: H
authors.lastname: Ahmed
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Gadelkarim
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Al-Azhar University, Cairo, 31724, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Elgebaly
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Zagazig University, El Shrakia, Egypt.|Student Research Unit, Zagazig University, El Shrakia, Egypt.
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Hassan
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt.
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: Abdel-Daim
authors.affiliation: Medical Research Group of Egypt, Cairo, Egypt.|Faculty of Medicine, Zagazig University, El Shrakia, Egypt.|Student Research Unit, Zagazig University, El Shrakia, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Negida
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D002986:Clinical Trials as Topic / Q000379:methods; D006801:Humans; D020381:Interleukin-17 / Q000037:antagonists & inhibitors / Q000097:blood; D011565:Psoriasis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C508717:IL17A protein, human; D020381:Interleukin-17; C571216:brodalumab