Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis

What is it about?

We conducted a network meta-analysis (NMA) to compare the efficacy and safety of biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic DMARDs in patients with psoriatic arthritis (PsA). There are relatively few head-to-head comparative trials in PsA, and NMA can provide indirect comparisons from randomised controlled trials using placebo as a `common denominator’ to help inform decision-makers. For the comparisons of clinical efficacy, the NMA focused on key outcomes on joints (American College of Rheumatology [ACR] criteria; Psoriatic Arthritis Response Criteria [PsARC]) and skin (Psoriasis Area and Severity Index [PASI]) at weeks 12?16 in patients who had not previously received bDMARD therapy (i.e. bDMARD-naïve patients). Evaluation of safety outcomes included the overall mixed population of bDMARD-naïve and -experienced patients. The NMA was comprehensive in that it compared up to 16 different treatment regimens, evaluated a wide range of clinical outcomes (not all are presented in the interest of brevity), and included a sensitivity analysis for key efficacy outcomes (ACR and PASI) to see if results in the overall mixed population were similar to those in bDMARD-naïve patients. Importantly, two regimens of ixekizumab were included in the NMA, as few previously conducted NMAs have included this recently approved interleukin-17A antagonist. Results of the NMA confirm the efficacy and acceptable safety profile of bDMARDs in patients with active PsA, and generally showed few statistically significant differences between most treatments. Findings of this NMA are also consistent with the results of a recently completed head-to-head study comparing ixekizumab versus adalimumab.

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