Augustin Matthias, Schuster Christopher, Mert Can, Nast Alexander
Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Eli Lilly and Company, Indianapolis, IN, USA.
Dermatol Ther (Heidelb). 2022 Aug;12(8):1711-1727. doi: 10.1007/s13555-022-00765-3. Epub 2022 Jul 14.
It can be challenging for dermatologists to keep abreast of the growing evidence from published indirect comparisons (ICs) of treatments for psoriasis. The objective of this analysis was to summarise comparative clinical efficacy and safety findings from ICs of systemic biologics for the treatment of moderate-to-severe psoriasis and to identify factors potentially affecting efficacy outcomes and their possible implications for clinical decision making.
An umbrella review of short- and long-term efficacy and safety findings from 26 ICs visually compared 90% improvement in Psoriasis Area Severity Index (PASI90) treatment rankings and three safety outcome rankings side by side. Pearson's correlation coefficients measured the strength of the association between each pair of ICs on the basis of identified factors that could potentially affect efficacy findings.
Some consistency in short-term PASI90 efficacy rankings was observed for certain drugs, although rankings for most drugs varied by IC. Factors potentially affecting efficacy outcomes included the use of different methodologies for head-to-head comparison and statistical analyses, and variation in drugs and classes included treatment dosing and duration, outcome definitions and effect measures reported between ICs. Considerable variation in these factors was found across all 26 ICs. Comparative safety information of value to physicians was limited.
Substantial differences were identified between ICs in factors that could potentially affect efficacy outcomes. Treatment rankings must be interpreted alongside actual differences in IC outcomes to allow conclusions on clinical relevance. Drugs within a class cannot be considered of equal efficacy: therapies should be considered individually rather than by class.
皮肤科医生要跟上已发表的银屑病治疗间接比较（IC）中不断增加的证据可能具有挑战性。本分析的目的是总结系统性生物制剂治疗中重度银屑病的IC比较临床疗效和安全性结果，并确定可能影响疗效结果的因素及其对临床决策的潜在影响。
对26项IC的短期和长期疗效及安全性结果进行一项综合评价，直观地并排比较银屑病面积和严重程度指数改善90%（PASI90）的治疗排名以及三项安全性结果排名。皮尔逊相关系数根据可能影响疗效结果的已确定因素，测量每对IC之间关联的强度。
某些药物在短期PASI90疗效排名上存在一些一致性，尽管大多数药物的排名因IC而异。可能影响疗效结果的因素包括用于直接比较和统计分析的方法不同，以及IC之间药物和类别差异，包括治疗剂量和持续时间、结果定义以及报告的效应测量指标。在所有26项IC中发现这些因素存在相当大的差异。对医生有价值的比较安全性信息有限。
在可能影响疗效结果的因素方面，IC之间存在重大差异。治疗排名必须结合IC结果的实际差异进行解读，以便得出临床相关性结论。同一类别的药物不能被认为具有同等疗效：应单独考虑各种疗法，而不是按类别考虑。
