Biologic Therapy for Psoriatic Arthritis or Moderate to Severe Plaque Psoriasis: Systematic Review with Pairwise and Network Meta-Analysis
DOI:
https://doi.org/10.6000/1929-6029.2014.03.02.1Keywords:
Meta-analysis, Mixed treatment comparison, Network meta-analysis, Plaque psoriasis, Psoriasis, Psoriatic arthritis, Systematic reviewAbstract
Background: A comprehensive assessment of the risk-benefit profile of biologic agents in psoriasis is lacking. We conducted a network meta-analysis of randomized trials on biologic agents in psoriasis.
Methods: Trials on biologic agents in psoriasis (including psoriatic arthritis) were sought in several databases. Endpoints were ≥75% Reduction in the Psoriasis Area and Severity Index (PASI75), ≥20% improvement in the American College of Rheumatology core set of outcomes (ACR20), serious adverse events (SAE), and adverse events (AE) at the longest available non-cross-over follow-up. Random-effect methods were used to obtain pairwise and network pooled estimates.
Results: A total of 52 trials with 17,617 patients and 9 different biologic agents included, with 52% affected by psoriatic arthritis. After an average follow-up of 18 weeks, treatment with placebo was associated with a 5.9% (5.2%-6.6%) rate of PASI75, 17.4% (15.1%-19.6%) of ACR20, 2.4% (1.9%-2.8%) of SAE, and 51.8% (50.2%-53.4%) of AE. Several biologic agents provided higher PASI75 rates than placebo, with golimumab yielding the most favorable results (relative risk [RR]=14.02 [6.85-17.11]). Accordingly, several agents provided higher ACR20 rates than placebo, with infliximab yielding the most favorable results (RR=3.02 [1.67-4.55]). Overall, rates of SAE and AE were higher for several but not all biologic agents versus placebo, with golimumab being associated with the most favorable results for SAE (RR=0.40 [0.11-1.41]), and abatacept for AE (RR=1.00 [0.79-1.22]).
Conclusions: Efficacy and safety of biologic agents for psoriasis differ, and clinicians should bear in mind these features to maximize safety and efficacy in the individual patient.
References
Parisi R, Symmons DP, Griffiths CE, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013; 133: 377-85. http://dx.doi.org/10.1038/jid.2012.339 DOI: https://doi.org/10.1038/jid.2012.339
Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58: 826-50. http://dx.doi.org/10.1016/j.jaad.2008.02.039 DOI: https://doi.org/10.1016/j.jaad.2008.02.039
Rustin MH. Long-term safety of biologics in the treatment of moderate-to-severe plaque psoriasis: review of current data. Br J Dermatol 2012; 167: s3-11. http://dx.doi.org/10.1111/j.1365-2133.2012.11208.x DOI: https://doi.org/10.1111/j.1365-2133.2012.11208.x
Biondi-Zoccai G, Lotrionte M, Landoni G, Modena MG. The rough guide to systematic reviews and meta-analyses. HSR Proc Intensive Care Cardiovasc Anesth 2011; 3: 161-73 Available from URL: http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3484632/
Lin VW, Ringold S, Devine EB. Comparison of ustekinumab with other biological agents for the treatment of moderate to severe plaque psoriasis: a bayesian network meta-analysis. Arch Dermatol 2012; 148: 1403-10. http://dx.doi.org/10.1001/2013.jamadermatol.238 DOI: https://doi.org/10.1001/2013.jamadermatol.238
Migliore A, Bizzi E, Broccoli S, Laganà B. Indirect comparison of etanercept, infliximab, and adalumimab for psoriatic arthritis: mixed treatment comparison using placebo as common comparator. Clin Rheumatol 2012; 31: 193-4. http://dx.doi.org/10.1007/s10067-011-1862-7 DOI: https://doi.org/10.1007/s10067-011-1862-7
Reich K, Burden AD, Eaton JN, Hawkins NS. Efficacy of biologics in the treatment of moderate to severe psoriasis: a network meta-analysis of randomized controlled trials. Br J Dermatol 2012; 166: 179-88. http://dx.doi.org/10.1111/j.1365-2133.2011.10583.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10583.x
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700. http://dx.doi.org/10.1136/bmj.b2700 DOI: https://doi.org/10.1136/bmj.b2700
Biondi-Zoccai GG, Agostoni P, Abbate A, Testa L, Burzotta F. A simple hint to improve Robinson and Dickersin's highly sensitive PubMed search strategy for controlled clinical trials. Int J Epidemiol 2005; 34: 224-5. http://dx.doi.org/10.1093/ije/dyh311 DOI: https://doi.org/10.1093/ije/dyh311
Kothary N, Diak IL, Brinker A, Bezabeh S, Avigan M, Dal Pan G. Progressive multifocal leukoencephalopathy associated with efalizumab use in psoriasis patients. J Am Acad Dermatol 2011; 65: 546-51. http://dx.doi.org/10.1016/j.jaad.2010.05.033 DOI: https://doi.org/10.1016/j.jaad.2010.05.033
D'Ascenzo F, Biondi-Zoccai G. Network meta-analyses: the "white whale" for cardiovascular specialists. J Cardiothorac Vasc Anesth 2014; 28: 169-73. http://dx.doi.org/10.1053/j.jvca.2013.01.004 DOI: https://doi.org/10.1053/j.jvca.2013.01.004
Greco T, Landoni G, Biondi-Zoccai G, D'Ascenzo F, Zangrillo A. A Bayesian network meta-analysis for binary outcome: how to do it. Stat Methods Med Res 2013 Oct 28 [Epub ahead of print]. http://dx.doi.org/10.1177/0962280213500185 DOI: https://doi.org/10.1177/0962280213500185
van Valkenhoef G, Tervonen T, de Brock b, Hillege H. Algorithmic parameterization of mixed treatment comparisons Stat Comput 2012; 22: 1099-111. http://dx.doi.org/10.1007/s11222-011-9281-9 DOI: https://doi.org/10.1007/s11222-011-9281-9
Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2013 Oct 28 [Epub ahead of print]. http://dx.doi.org/10.1038/jid.2013.446 DOI: https://doi.org/10.1038/jid.2013.446
Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature 2007; 445: 866-73. http://dx.doi.org/10.1038/nature05663 DOI: https://doi.org/10.1038/nature05663
Schottelius AJ, Moldawer LL, Dinarello CA, Asadullah K, Sterry W, Edwards CK 3rd. Biology of tumor necrosis factor-alpha- implications for psoriasis. Exp Dermatol 2004; 13: 193-222. http://dx.doi.org/10.1111/j.0906-6705.2004.00205.x DOI: https://doi.org/10.1111/j.0906-6705.2004.00205.x
Lowes MA, Kikuchi T, Fuentes-Duculan J, et al. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. J Invest Dermatol 2008; 128: 1207-11. http://dx.doi.org/10.1038/sj.jid.5701213 DOI: https://doi.org/10.1038/sj.jid.5701213
Nestle FO, Di Meglio P, Qin JZ, Nickoloff BJ. Skin immune sentinels in health and disease. Nat Rev Immunol 2009; 9: 679-91. http://dx.doi.org/10.1038/nri2622 DOI: https://doi.org/10.1038/nri2622
Nograles KE, Zaba LC, Shemer A, et al. IL-22-producing "T22" T cells account for upregulated IL-22 in atopic dermatitis despite reduced IL-17-producing TH17 T cells. J Allergy Clin Immunol 2009; 123: 1244-52. http://dx.doi.org/10.1016/j.jaci.2009.03.041 DOI: https://doi.org/10.1016/j.jaci.2009.03.041
Schmitt J, Rosumeck S, Thomaschewski G, Sporbeck B, Haufe E, Nast A. Efficacy and safety of systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol 2014; 170: 274-303. http://dx.doi.org/10.1111/bjd.12663 DOI: https://doi.org/10.1111/bjd.12663
Nelson AA, Pearce DJ, Fleischer AB Jr, Balkrishnan R, Feldman SR. Cost-effectiveness of biologic treatments for psoriasis based on subjective and objective efficacy measures assessed over a 12-week treatment period. J Am Acad Dermatol 2008; 58: 125-35. http://dx.doi.org/10.1016/j.jaad.2007.09.018 DOI: https://doi.org/10.1016/j.jaad.2007.09.018
Biondi-Zoccai G, Landoni G, Modena MG. A journey into clinical evidence: from case reports to mixed treatment comparisons. HSR Proc Intensive Care Cardiovasc Anesth 2011;3:93-6 Available from URL: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC3484626/
Biondi-Zoccai G. In the kingdom of the blind, the one-eyed man is king: the case for the International Journal of Statistics in Medical Research. Int J Stats Med Res 2013; 2: i-iv. Available from URL: http://www.lifescienceglobal.com/ home/cart?view=product&id=409
Tzellos T, Kyrgidis A, Zouboulis CC. Re-evaluation of the risk for major adverse cardiovascular events in patients treated with anti-IL-12/23 biological agents for chronic plaque psoriasis: a meta-analysis of randomized controlled trials. J Eur Acad Dermatol Venereol 2013; 27: 622-7. http://dx.doi.org/10.1111/j.1468-3083.2012.04500.x DOI: https://doi.org/10.1111/j.1468-3083.2012.04500.x
Ryan C, Leonardi CL, Krueger JG, et al. Association between biologic therapies for chronic plaque psoriasis and cardiovascular events: a meta-analysis of randomized controlled trials. JAMA 2011; 306: 864-71. http://dx.doi.org/10.1001/jama.2011.1211 DOI: https://doi.org/10.1001/jama.2011.1211
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Copyright (c) 2014 Mariangela Peruzzi, Delia Colombo, Elena De Falco, Isotta Chimenti, Antonio Abbate, Giacomo Frati, Giuseppe Biondi-Zoccai
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