What Are the Most Effective Biologics for Treating Plaque Psoriasis?

Researchers compared the effectiveness of biologics approved in Europe for the treatment of plaque psoriasis based on their performance as measured by primary endpoints in clinical trials.

In “Efficacy of biologics in the treatment of moderate-to-severe plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials with different time points,” published in the Journal of the European Academy of Dermatology and Venereology, the authors reported on findings from a meta-analysis of the literature designed to evaluate the efficacy of biologics in the treatment of moderate-to-severe plaque psoriasis.

The authors searched several databases to identify randomized, placebo-controlled studies of biologics currently authorized in the European Union (EU) in adult patients with a diagnosis of moderate-to-severe plaque psoriasis. They estimated efficacy “using risk difference (RD) of Psoriasis Area and Severity Index (PASI) 50, PASI 75 and PASI 90 response rates at the endpoint in clinical trials, at the end of the induction phase (week 24) and at the time points recommended for evaluation of primary failure in the approved” summaries of product characteristics (SmPCs).

According to the summary of results, “at the primary endpoint times, infliximab (at week 10) has the greatest probability of response with respect to placebo for all PASI-based efficacy measures (PASI 50, PASI 75 and PASI 90). At the end of the induction phase (week 24), ustekinumab 45 mg has the greatest probability of achieving PASI 75 response (RD 75.5%, 95%CI 71.5-79.4%], followed by ustekinumab 90 mg, infliximab, adalimumab and etanercept. At the time points recommended for primary failure assessment according to the approved SmPCs, ustekinumab 45 mg (at week 28) also has the greatest probability of achieving PASI 50 response [RD 80.7%, 95%CI 77.2-84.2%], followed by ustekinumab 90 mg, infliximab, adalimumab and etanercept.”

The authors concluded that “From a clinical practice perspective, and in terms of the most relevant efficacy measures (PASI 50 and PASI 75) and time points (end of induction phase [week 24] and time to assess primary failure as per the SmPCs), in the currently approved conditions of use ustekinumab is the most efficacious therapeutic alternative for moderate-to-severe plaque psoriasis, followed by infliximab, adalimumab and etanercept.”