School of Public Health, Brown University, Providence, RI, U.S.A.
Institute for Clinical and Economic Review, Boston, MA, U.S.A.
Br J Dermatol. 2019 Feb;180(2):282-288. doi: 10.1111/bjd.17335. Epub 2018 Dec 21.
There are numerous systemic medications in use for psoriasis, with additional investigational agents being studied. However, head-to-head, randomized clinical trials are rare and cannot feasibly compare all treatments. A network meta-analysis (NMA) synthesizes the available evidence to provide estimates for all pairwise comparisons. Here, we summarize and appraise two recent NMAs that assessed systemic therapies for moderate-to-severe psoriasis.
Two systematic reviews searched databases and the grey literature to identify relevant randomized clinical trials.
The reviews mostly included trials that involved adults with moderate-to-severe psoriasis. One of the reviews also included two trials involving children.
Interventions common to both reviews include adalimumab, etanercept, infliximab, ustekinumab, ixekizumab, secukinumab and methotrexate. One of the reviews included additional interventions, primarily other biological agents along with new small-molecule treatments and systemic conventional treatments.
One review focused on 'clear/nearly clear' and withdrawals from adverse events as study outcomes, while the second review focused on improvement of ≥ 90% measured on the Psoriasis Area and Severity Index (PASI 90) and serious adverse events.
Additional outcomes included quality of life, PASI 75, Physician's Global Assessment of 0/1 and any adverse event.
Overall, both NMAs are of high quality and provide a comprehensive summary of the evidence base and treatment effects. Results, in terms of both estimates and rankings, suggest that newer biologics targeting the interleukin (IL)-12/23 and IL-17 axes appear to be more effective than older biologics and oral agents.
Patients, clinicians and policy makers can use the relative efficacy assessments of NMAs to inform decision making regarding the clearance of psoriasis skin lesions at relevant time points and improvement in quality of life.
有许多用于治疗银屑病的全身性药物，并且正在研究其他的研究药物。但是，头对头的随机临床试验很少，并且实际上无法比较所有治疗方法。网络荟萃分析（NMA）综合了现有证据，以提供所有成对比较的估计值。在这里，我们总结并评估了两项最近评估中重度银屑病系统性治疗的 NMA。
两项系统评价检索了数据库和灰色文献，以确定相关的随机临床试验。
这两项综述主要纳入了涉及中重度银屑病成人的试验。其中一项综述还纳入了两项涉及儿童的试验。
这两项综述共同包括的干预措施包括阿达木单抗、依那西普、英夫利昔单抗、乌司奴单抗、依奇珠单抗、司库奇尤单抗和甲氨蝶呤。其中一项综述还包括其他干预措施，主要是其他生物制剂以及新型小分子治疗和全身常规治疗。
一项综述侧重于“清除/接近清除”和因不良事件而停药作为研究结局，而另一项综述则侧重于改善≥90%的银屑病面积和严重程度指数（PASI 90）和严重不良事件。
其他结局包括生活质量、PASI 75、医生对 0/1 的总体评估和任何不良事件。
总体而言，这两项 NMA 质量都很高，提供了证据基础和治疗效果的全面总结。就估计值和排名而言，结果表明，针对白细胞介素（IL）-12/23 和 IL-17 轴的新型生物制剂似乎比旧的生物制剂和口服药物更有效。
患者、临床医生和决策者可以使用 NMA 的相对疗效评估来告知有关在相关时间点清除银屑病皮损和改善生活质量的决策。
