Short-term efficacy and safety of new biologic agents targeting IL-23/Th17 pathway for moderate to severe plaque psoriasis: a systematic review and network meta-analysis.

A new generation of biologics targeting IL-23/Th17 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 (n=10,629) were identified by a comprehensive systematic literature review (PROSPERO 2015:CRD42015025472). Quality of evidence was assessed following Cochrane compliant rules and GRADE 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 (OR) of direct and indirect comparisons among the therapeutic options. There were 6 direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and the indirect evidence. From the available evidence, infliximab 5mg.kg-1 every eight weeks (OR: 118.89; 95%CI: 60.91-232.04) and secukinumab 300mg every four weeks (OR: 87.07;95%CI: 55.01-137.82) are shown as among the most effective short-term treatment, but are ranked as the biologic most likely to produce any adverse event (AE) or an infectious AE, respectively. Ustekinumab 90mg every twelve weeks, the third most efficacious (OR: 73.67; 95%CI: 46.97-115.56), was the only agent that did not show increased risk of adverse events when compared with placebo. Treatment recommendations should also consider long term outcomes and costs. This article is protected by copyright. All rights reserved.