Quantitative Evaluation of Biologic Therapy Options for Psoriasis: A Systematic Review and Network Meta-Analysis–Correction

We recently performed an updated network meta-analysis (NMA) to inform the British Association of Dermatologists guidelines for biologic therapy psoriasis (Smith et al., 2020Smith C.H. Yiu Z.Z. Bale T. Burden A.D. Coates L.C. Edwards W. al.British 2020 – a rapid update [e-pub ahead print].Br J Dermatol. 2020; 183: 628-637Crossref PubMed Scopus (39) Google Scholar). During this process, we identified data entry errors in our original 2017 NMA publication (Jabbar-Lopez 2017Jabbar-Lopez Z.K. Z.Z.N. Ward V. Exton L.S. Mohd Mustapa M.F. Samarasekera E. al.Quantitative evaluation options psoriasis: systematic review and meta-analysis.J Invest 2017; 137: 1646-1654Abstract Full Text PDF (71) Scholar) related specified number patients randomized each treatment arm some trials. Therefore, reran with corrected (see resulting amendments Corrected Table 1). find conclusions remain same. Specifically, hierarchical cluster analyses show that adalimumab, secukinumab, ustekinumab are again comparable respect high efficacy tolerability. Etanercept, methotrexate, placebo form distinct owing low-to-moderate tolerability; infliximab ixekizumab relatively lower tolerability than other agents at 12–16 weeks (Corrected Figure 1 vs. 3 NMA).Corrected 1NMA Results Summary Three Main Outcomes Weeks: Clear and/or Nearly Clear, Mean Change DLQI, Withdrawal Due Adverse EventsBiologicsComparisonsAnticipated Absolute Effect (95% CI)1Absolute effects were calculated from multiplication NMA-derived relative estimates by assumed control baseline risk based on weighted event rate across all studiesNumber Participants, Direct Evidence (Number Studies)NNT or NNH2NNT NNH was as reciprocal corresponding risk.OR CI)Without Intervention, per 1,000With 1,000Difference, 1,000Clear (Minimal Residual Activity PASI > 90/0 PGA) wksETAETA versus PBO11.37 (8.72–14.83)16221205 more (150 260 more)4,937 (12)5 (4, 7)ADAADA PBO22.75 (13.75–37.64)16445429 (343 515 more)2,200 (6)2 (2, 3)ADA ETA2.00 (1.13–3.53)221445224 (122 326 more)0 (0)4 (3, 8)INFINF PBO36.56 (17.92–74.61)16508492 (401 583 more)1,591 (4)2 2)INF ETA3.22 (1.51–6.84)221508287 (185 390 more)50 (1)3 5)INF ADA1.61 (0.79–3.26)44550863 (59 less 186 (0)NSUSTUST PBO20.67 (15.89–26.88)16441425 (361 489 more)4,264 (9)2 3)UST ETA1.82 (1.45–2.28)221441220 (140 300 more)903 (1)5 7)UST ADA0.91 (0.52–1.60)4454414 (112 103 (0)NSUST INF0.57 (0.27–1.20)50844167 (178 43 MTX1.70 (0.80–3.61)179441261 (106 417 9)SECSEC PBO28.03 (20.91–37.59)16474458 (375 540 more)2,470 (5)2 3)SEC ETA2.47 (1.94–3.13)221474253 (158 348 more)980 (1)4 6)SEC ADA1.23 (0.69–2.20)44547429 (91 148 (0)NSSEC INF0.77 (0.36–1.65)50847434 (157 88 MTX2.30 (1.07–4.95)179474294 (130 459 (0)3 8)SEC UST1.36 (1.10–1.67)44147433 (64 131 more)676 (1)NSIXEIXE PBO34.49 (24.85–47.85)16635619 (524 714 more)3,268 (1, 2)IXE ETA3.03 (2.44–3.77)221635414 (312 more)2,209 (2)2 3)IXE ADA1.52 (0.83–2.76)445635190 (61 318 (0)5 16)IXE INF0.94 (0.43–2.05)508635127 (4 257 (0)NSIXE MTX2.83 (1.30–6.17)179635455 (284 626 (0)2 4)IXE UST1.67 (1.24–2.25)441635194 (80 308 12)IXE SEC1.23 (0.90–1.68)474635161 (36 286 (0)6 28)Mean DLQI PBO−6.00 (−7.3 −462)———1,101 (2)—ADAADA PBO−7.20 (−8.76 −5.65)———1,606 (4)—ADA ETA−1.21 (−3.29 0.87)———0 (0)—INFINF PBO−8.42 (−9.82 −7.01)———1,591 (4)—INF ETA−2.42 (−4.39 −0.45)———0 (0)—INF ADA−1.21 (−3.32 0.90)———0 (0)—USTUST PBO−7.60 (−8.58 −6.62)———3,027 (7)—UST ETA−1.61 (−3.28 0.06)———0 (0)—UST ADA−0.40 (−2.24 1.44)———0 INF0.81 (−0.90 2.52)———0 MTX−4.44 (−7.30 −1.57)———0 (0)—SECSEC PBO−8.35 (−9.46 −7.25)———2,282 (5)—SEC ETA−2.36 (−3.98 −0.74)———0 (0)—SEC ADA−1.15 (−3.06 0.77)———0 INF0.06 (−1.72 1.84)———0 MTX−5.18 (−8.10 −2.27)———0 UST−0.75 (−2.10, 0.60)———676 (1)—IXEIXE PBO−8.05 (−9.68 –6.42)———1,830 (2)—IXE ETA−2.05 (−3.66 –0.45)———2,209 ADA−0.84(−3.10 1.41)———0 (0)—IXE INF0.37 (−1.78 MTX−4.88 (−8.03 −1.73)———0 UST−0.45 (−2.34 SEC0.30 (−1.60 2.20)———0 (0)—Withdrawal due Events PBO1.08 (0.72–1.64)19234 (3 10 more)4,285 (11)NSADAADA PBO0.68 (0.42–1.12)19118 (20 5 (6)NSADA ETA0.63 (0.33–1.20)231111 (25 (0)NSINFINF PBO2.53 (1.22–5.22)195132 (11 53 more)964 (2)31 (19, 91)INF ETA2.33 (1.05–5.17)235128 (6 50 (1)35 (20, 154)INF ADA3.70 (1.58–8.66)115139 (16 63 (0)25 (16, 63)USTUST (0.43–1.07)19163 (9 (9)NSUST ETA0.62 (0.36–1.08)23166 (15 2 (1)NSUST ADA0.99 (0.51–1.94)11165 19 INF0.27 (0.11–0.63)511635 (56 13 less)0 (0)29 (18, 78)2NNT risk.UST MTX0.64 (0.24–1.71)31613 (19 45 (0)NSSECSEC (0.37–1.25)19154 4 more)2,686 (6)NSSEC (0.32–1.23)23157 (1)NSSEC ADA1.00 (0.46–2.18)11154 (0.11–0.69)511535 (58 (0)28 (17, 75)2NNT risk.SEC MTX0.65 (0.23–1.86)31512 UST1.01 (0.50–2.03)16151 (10 8 PBO1.65 (0.93–2.96)19289 (1 17 more)3,126 (3)112 (59, 1130)IXE ETA1.53 (0.85–2.75)23285 14 (2)NSIXE ADA2.42 (1.13–5.18)112817 (2 31 (0)60 (32, 540)IXE INF0.65 (0.26–1.63)512823 (45 (0)44 (22, 1828)2NNT risk.IXE MTX1.57 (0.56–4.43)32825 (8 57 UST2.44 (1.20–4.99)162812 22 (0)85 (46, 565)IXE SEC2.42 (1.07–5.46)152813 23 (0)79 (43, 586)Abbreviations: ADA, adalimumab; CI, confidence interval; Dermatology Life Quality Index; ETA, etanercept; INF, infliximab; IXE, ixekizumab; MTX, methotrexate; NMA, meta-analysis; NNH, numbers needed harm; NNT, treat; NS, not significant; OR, odds ratio; PBO, placebo; PGA, global assessment; SEC, secukinumab; UST, ustekinumab.1 studies2 NNT risk. Open table new tab Abbreviations: ustekinumab. For completeness, have also included here plot joint rankings analysis QOL (mean change Index) weeks, which is unchanged compared 2). The rerun using amended dataset shows infliximab, ixekizumab, secukinumab now objective (clear nearly clear) subjective 3). Compared previous analyses, these separately adalimumab ustekinumab, moderate two outcomes.Corrected 3Plot clustering SUCRA estimates. Combined DLQI) outcomes weeks. SUCRA, surface under cumulative ranking curve; ustekinumab.View Large Image ViewerDownload Hi-res image Download (PPT) All datasets used been checked verified correct part analyses. Please accept corrections publication. Catherine H. Smith: http://orcid.org/0000-0001-9918-1144 Satveer K. Mahil: http://orcid.org/0000-0003-4692-3794 Zenas Z. N. Yiu: http://orcid.org/0000-0002-1831-074X Laura C. Coates: http://orcid.org/0000-0002-4756-663X Richard Woolf: http://orcid.org/0000-0003-3200-0075 Lina Manounah: http://orcid.org/0000-0001-6129-6624 Martinsixtus Ezejimofor: http://orcid.org/0000-0002-2510-9964 Lesley S. Exton: https://orcid.org/0000-0003-0073-1885 M. Firouz Mustapa: https://orcid.org/0000-0003-4070-0696 CHS received departmental research funding AbbVie, Boehringer Ingelheim, Glaxo Smith Kline, Leo, Pfizer, Novartis, Regeneron, Swedish Orphan Biovitrum AB, Roche principal investigator within consortia industry partners biomap.eu psort.org.uk). SKM Celgene, Eli Lilly, Janssen–Cilag, Sanofi, UCB. TB has attended Novartis-chairing meetings 2019–2020. ADB honoraria advisory boards lecturing Almirall, LCC Amgen, Biogen, Gilead Sciences, Janssen Pharmaceutica, RM expenses Janssen–Cilag (personal financial interest). remaining authors state no conflict interest. This project supported Dermatologists. Mahil funded Medical Research Council (MRC) Clinical Academic Partnership award (MR/T02383X/1). MRC MR/L011808/1. National Institute Health (NIHR) Lectureship through University Manchester. NIHR Clinician Scientist award. Biomedical Centre (BRC) King’s College London Guy’s St Thomas’ NHS Foundation Trust Oxford BRC. views expressed those author(s) necessarily NHS, Department Health. Quantitative Evaluation Biologic Therapy Options Psoriasis: A Systematic Review Network Meta-AnalysisJournal Investigative DermatologyVol. 137Issue 8PreviewMultiple treatments licensed psoriasis. lack head-to-head controlled trials makes choosing between them difficult patients, clinicians, guideline developers. To establish their tolerability, searched MEDLINE, PubMed, Embase, Cochrane skin identify direct indirect evidence comparing biologics one another, placebo. Full-Text Access