Among systemic treatments for plaque psoriasis, brodalumab, guselkumab, ixekizumab, and risankizumab-rzaa were found to be associated with the highest Psoriasis Area and Severity Index (PASI) response rates.

To assess the comparative efficacy of systemic treatments for psoriasis, study authors searched Embase, MEDLINE and the Cochrane Central Register for studies evaluating the short- and long-term efficacy of biologic and oral agents. Studies included in the analysis were phase 2, 3, or 4 randomized clinical trials assessing therapies used in adults with moderate to severe psoriasis that have been approved by the US Food and Drug Administration and the European Medicines Agency. 

Only studies reporting PASI assessment of 75%, 90%, and 100% reductions (PASI 75, 90, and 100) at 10 to 16 weeks (short-term efficacy) or 44 to 60 weeks (long-term efficacy) were included in the analysis. Short-term and long-term PASI 75, 90, and 100 response rates were the main outcomes of the review. 

The analysis, which included a total of 60 trials, revealed that the highest response rates were associated with the use of risankizumab-rzaa, brodalumab, ixekizumab, and guselkumab. PASI 90 rates at weeks 10 to 16 were reported to be 71.6% for risankizumab-rzaa (95% credible interval [Crl], 67.5-75.4), 70.8% for brodalumab (95% CrI, 66.8-74.6), 70.6% for ixekizumab (95% CrI, 66.8-74.6), and 67.3% for guselkumab (95% CrI, 62.5-71.9). 

At weeks 44 to 60, PASI 90 rates were reported to be 79.4% for risankizumab-rzaa (95% confidence interval [CI], 75.5-82.9), 76.5% for guselkumab (95% CI, 72.1-80.5), 74.0% for brodalumab (95% CI, 69.3-78.1), and 73.9% for ixekizumab (95% CI, 69.9-77.5). Additionally, it was noted that the results were consistent for both short- and long-term PASI 75 and 100 reponses. 

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“In the absence of head-to-head randomized clinical trials of treatments for moderate to severe plaque psoriasis, this study provides what we believe to be a comprehensive assessment of the comparative short-term and long-term efficacy among several novel treatments,” the authors concluded.


Armstrong AW, Puig L, Joshi A, et al. Comparison of Biologics and Oral Treatments for Plaque Psoriasis: A Meta-analysis . JAMA Dermatol. Published online February 05, 2020. doi:10.1001/jamadermatol.2019.4029