Evaluación Cuantitativa de las Opciones de Terapia Biológica para la Psoriasis: Revisión Sistemática y Meta-Análisis de la Red.

Multiple biologic treatments are licensed for psoriasis. The lack of head-to-head randomised controlled trials (RCTs) makes choosing between them difficult for patients, clinicians and guideline developers. To establish their relative efficacy and tolerability, we searched MEDLINE, PubMed, Embase and Cochrane for RCTs of licensed biologic treatments for skin psoriasis. We performed a network meta-analysis to identify direct and indirect evidence comparing biologics to one another, methotrexate or placebo. We combined this with hierarchical cluster analysis to consider multiple outcomes related to efficacy and tolerability in combination for each treatment. Study quality, heterogeneity and inconsistency were evaluated. Direct comparisons from 41 RCTs (20,561 participants) were included. All included biologics were efficacious compared with placebo or methotrexate at 3-4 months. Overall, cluster analysis showed adalimumab, secukinumab and ustekinumab were comparable in terms of high efficacy and tolerability. Ixekizumab and infliximab were differentiated by very high efficacy but poorer tolerability. The lack of longer-term controlled data limited our analysis to short-term outcomes. Trial performance may not equate to real-world performance, and so results need to be considered alongside real-world, long-term safety and effectiveness data. These data suggest that it is possible to discriminate between biologics to inform clinical practice and decision-making. PROSPERO 2015:CRD42015017538.