Chen Jiaqi, Yin Xinbo, Kan Xuewei, Yao Pingping, Tang Jun
Department of Dermatology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Xiangya Hospital Central South University, Changsha, China.
Clin Rheumatol. 2025 Aug 22. doi: 10.1007/s10067-025-07597-4.
To assess deucravacitinib's efficacy and safety against selected treatments for moderate-to-severe plaque psoriasis via network meta-analysis.
Relevant studies were selected via a systematic literature search in PubMed, EMBASE, Web of Science, and Cochrane Library databases. To assess the ORs with corresponding 95% CIs for outcomes including PASI 75, PASI 90, sPGA 0/1, and treatment discontinuation due to adverse events over the 10-16-week timeframe, a network meta-analysis was performed utilizing R software. Treatment efficacy and safety were comparatively ranked by calculating the surface under the cumulative ranking curve (SUCRA).
This study included 66 trials of 27,074 patients. All interventions outperformed placebo in short-term outcomes. Infliximab ranked the highest for achieving PASI 75 (OR, 0.01; 95% CI, 0.00 to 0.01, moderate-to-high-quality evidence). Bimekizumab ranked the highest for achieving PASI 90 (OR, 0.00; 95% CI, 0.00 to 0.01, moderate-to-high-quality evidence). Tildrakizumab ranked the highest for achieving sPGA 0/1 (OR, 0.01; 95% CI, 0.00 to 0.05, low-to-high-quality evidence). Brodalumab had the highest risk of discontinuation due to adverse events (OR, 1.28; 95% CI, 0.36 to 5.04, moderate-to-high-quality evidence).
Accumulating research, albeit of differing robustness, suggests that bimekizumab could potentially offer superior efficacy compared to other therapies in attaining both the PASI 75 and PASI 90 response thresholds in psoriasis treatment. Tildrakizumab appears to have achieved the highest proportion of participants reaching a static Physician's Global Assessment (sPGA) score of clear or almost clear (sPGA 0/1). Deucravacitinib has demonstrated moderate efficacy and tolerability; however, additional head-to-head comparative trials are warranted to substantiate its effects due to the paucity of existing studies. Key Points • The NMA of 66 RCTs reveals that infliximab, bimekizumab, and tildrakizumab are superior in achieving PASI 75, PASI 90, and sPGA 0/1, respectively, in moderate-to-severe plaque psoriasis, underscoring their therapeutic significance. • Deucravacitinib, an oral TYK2 inhibitor, outperforms placebo and apremilast in efficacy for moderate-to-severe plaque psoriasis. Its once-daily dosing may enhance adherence, presenting a promising oral therapy. • The study's strengths are its assessment of deucravacitinib's short-term effects, use of high-quality RCTs, and analytical rigor. Limitations involve varying trial durations and reporting biases. Sensitivity analyses were conducted to ensure robust findings.
通过网状Meta分析评估氘可来昔替尼对比中重度斑块状银屑病的选定治疗方案的疗效和安全性。
通过在PubMed、EMBASE、Web of Science和Cochrane图书馆数据库中进行系统文献检索来选择相关研究。为了评估在10 - 16周时间范围内包括PASI 75、PASI 90、静态医师全面评估（sPGA）0/1以及因不良事件导致治疗中断等结局的比值比（OR）及相应的95%置信区间（CI），使用R软件进行网状Meta分析。通过计算累积排序曲线下面积（SUCRA）对治疗疗效和安全性进行比较排序。
本研究纳入了27,074例患者的66项试验。所有干预措施在短期结局方面均优于安慰剂。英夫利昔单抗在实现PASI 75方面排名最高（OR，0.01；95% CI，0.00至0.01，中高质量证据）。比美吉珠单抗在实现PASI 90方面排名最高（OR，0.00；95% CI，0.00至0.01，中高质量证据）。替拉珠单抗在实现sPGA 0/1方面排名最高（OR，0.01；95% CI，0.00至0.05，低高质量证据）。布罗达单抗因不良事件导致停药的风险最高（OR，1.28；95% CI，0.36至5.04，中高质量证据）。
尽管研究的稳健性各异，但越来越多的研究表明，在银屑病治疗中，比美吉珠单抗在达到PASI 75和PASI 90反应阈值方面可能比其他疗法具有更高的疗效。替拉珠单抗似乎使达到静态医师全面评估（sPGA）评分为清除或几乎清除（sPGA 0/1）的参与者比例最高。氘可来昔替尼已证明具有中等疗效和耐受性；然而，由于现有研究较少，需要更多的直接对比试验来证实其效果。要点 • 66项随机对照试验的网状Meta分析表明，英夫利昔单抗、比美吉珠单抗和替拉珠单抗在中重度斑块状银屑病中分别在实现PASI 75、PASI 90和sPGA 0/1方面更具优势，凸显了它们的治疗意义。 • 氘可来昔替尼是一种口服酪氨酸激酶2（TYK2）抑制剂，在中重度斑块状银屑病的疗效方面优于安慰剂和阿普米司特。其每日一次给药可能会提高依从性，是一种有前景的口服疗法。 • 该研究的优势在于评估了氘可来昔替尼的短期效果、使用了高质量随机对照试验以及分析严谨。局限性包括试验持续时间不同和报告偏倚。进行了敏感性分析以确保结果的稳健性。
