Comparative efficacy and safety of biologics in moderate to severe plaque psoriasis: a multiple-treatments meta-analysis

Entwicklung der Patientencharakteristika und der Wirksamkeit der Biologika-Therapie bei Patienten des Österreichischen Psoriasis-Registers von 2004 bis 2022

Hintergrund und Ziele

In dieser Studie wurde untersucht, inwieweit die Einführung wirksamerer Medikamente in jüngster Zeit zu einer Verbesserung der Behandlungsergebnisse von Psoriasis‐Patienten im klinischen Alltag geführt hat.

Patienten und Methodik

Es wurden Patientencharakteristika und die Wirksamkeit der Therapie im ersten Behandlungsjahr bei Biologika‐naiven Patienten von 2004 bis heute analysiert, unabhängig von Therapiewechseln.

Ergebnisse

Die Daten von 2729 Patienten eigneten sich für die Analyse. Der Anteil der weiblichen Patienten stieg über die Jahre signifikant von 29,9% auf 36,2% (p < 0,028), während der Anteil der Patienten mit einer Psoriasis‐Arthritis von 36,6% auf 30,0% sank (p < 0,001). Außerdem nahm die Dauer der Psoriasis‐Erkrankung und der PASI‐Wert zu Beginn der Behandlung in Verlauf der Zeit signifikant ab. Die „letzte Beobachtung übernommen“ (LOCF)‐Analyse zeigte, dass das PASI‐90‐Ansprechen drei Monate nach Therapiebeginn von 18,9% auf 44,6% und 12 Monate nach Therapiebeginn von 32,9% auf 66,8% anstieg. Ebenso stiegen die PASI<3 Befunde von 33,2% auf 66,0% 3 Monate und von 41,9% auf 78,9% 12 Monate nach Behandlungsbeginn.

Schlussfolgerungen

Die kontinuierliche Einführung wirksamerer Biologika hat zu einer deutlichen Verbesserung des klinischen Ansprechens und der Patientenversorgung geführt. Dennoch erreicht auch heute noch, je nach gewähltem Endpunkt, jeder dritte bis fünfte Patient kein vollständig zufriedenstellendes Behandlungsergebnis (d.h. PASI 90 oder PASI ≤ 3).

Evolution of characteristics and biologic treatment effectiveness in patients of the Austrian psoriasis registry from 2004-2022

BACKGROUND AND OBJECTIVES

This study analyzed the extent to which the recent introduction of more effective treatments has led to an improvement in real-world psoriasis patients.

PATIENTS AND METHODS

Patient characteristics and the first-year treatment effectiveness in biologic-naive patients have been analyzed since 2004 until now, irrespective of treatment switches.

RESULTS

Data from 2,729 patients were eligible for this analysis. The proportion of female patients increased significantly over the years from 29.9% to 36.2% (p < 0.028), while the number of patients with psoriatic arthritis declined from 36.6% to 30.0% (p < 0.001). Moreover, the duration of psoriatic disease and PASI at the start of the treatment significantly decreased. Last observation carrief forward (LOCF) analysis indicated that PASI 90 response increased from 18.9 to 44.6% at 3 months and from 32.9 to 66.8% at 12 months after treatment started. Similary, the PASI ≤ 3 rates increased from 33.2% to 66.0% at 3 months and from 41.9% to 78.9% at 12 months after the treatment started.

CONCLUSIONS

The continuous introduction of more efficient biologics has led to significant improvements in patient care and clinical outcomes. Though one out of three to five patients, depending on the endpoint selected, nowadays still does not achieve an entirely satisfactory treatment response (i.e., PASI 90 or PASI ≤ 3).

Comparation of time-course, dose-effect, influencing factors and adverse events of biologics in the treatment of adults with moderate to severe plaque psoriasis

Introduction

Biologics is used for treating moderate to severe plaque psoriasis (MSPP), which represent one of the foremost therapeutic advancements in disease of dermatology. Up to now, the relative efficacy and safety across approved andinvestigational biologics for MSPP is still unclear.

Methods

This study aimed to comparative effectiveness of various biological treatments for MSPP measured by PASI75, PASI90 and PASI100 (The ratio of patients whose Psoriasis Area and Severity Index score (PASI) decreased by ≥ 75%, 90% and 100% compared with baseline, respectively). In addition, random models were used together with a Bayesian method to compare direct and indirect Adverse Events (AEs) of biologics with placebo, to make probabilistic statements and predictions on their AEs. The analytic data set was made up of summarized data from 54 trials, including 27,808 patients, with treatment of 17 biologics. Three mathematic models with nonparametric placebo evaluations were established to characterize the longitudinal direction profile for the three efficacy measures as above mentioned.

Results

Our results showed significant differences among treatments. Bimekizumab, sonelokimab, and ixekizumab were found to be the most effective treatments among the biologics. The effects of covariate were further evaluated, patients' age, body weight, duration of disease and percentage of patients previously treated with a biological therapy showed impact on the efficacy. In addition, we found that ixekizumab and risankizumab displayed relatively stable as for efficacy and safety.

Discussion

Our findings provide valuable insights into the comparative effectiveness and safety of biologics for MSPP treatment. These results may aid in clinical decision-making and ultimately improve patient outcomes.

Eczematized psoriasis - a frequent but often neglected variant of plaque psoriasis

Psoriasis is a common chronic inflammatory skin disease that causes systemic inflammation and severely impacts the patient's quality of life. Several highly effective therapeutics for psoriasis have been approved in recent years. However, in real life, a high proportion of patients either do not experience the clinical improvement observed in clinical trials or develop a secondary loss of efficacy. This may be a result of unrecognized endotypes of psoriasis that need to be characterized in greater depth to enable selection of an appropriate therapy. Eczematized psoriasis, which occurs in approximately 5-10% of patients with psoriasis, is an often-neglected variant of psoriasis. The term "eczematized psoriasis" refers to patients developing psoriasis with similarities to eczema. These patients typically present with severe itching, and skin biopsies often reveal eosinophil granulocytes, serum crusts, or spongiosis, which are frequently observed in eczema. From an immunological perspective, additional signaling pathways that are responsible for eczema reactions might be activated in eczematized psoriasis compared to classical plaque psoriasis. This review summarizes the key clinical, histological, and immunological features of eczematized psoriasis, proposes diagnostic criteria, and evaluates the therapeutic options for eczematized psoriasis.

Coverage of Specialty Drugs for Psoriasis and Psoriatic Arthritis by Commercial Insurance Companies

Background

Specialty medications provide effective treatment with limited adverse effects to patients with psoriasis and psoriatic arthritis; however, variable coverage and high costs often create a barrier to treatment for patients with commercial health insurance.

Objective

We aimed to evaluate coverage of psoriasis and psoriatic arthritis specialty medications by commercial insurance companies.

Methods

We compiled data regarding specialty drug coverage for psoriasis and psoriatic arthritis using Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database and analyzed the data for any notable trends. The SPEC database lists coverage decisions for 158 specialty drugs by 17 of the largest US commercial health plans, as well as data regarding the types of evidence cited by these insurance plans when making coverage decisions.

Results

Our results showed that insurance plans tend to be more restrictive than the U.S. Food and Drug Association (FDA) label when covering medications for psoriasis and psoriatic arthritis. Furthermore, medications for psoriatic arthritis tended to be less restricted than for psoriasis, and medications were most commonly approved as second line agents for both indications.

Conclusion

Our analysis confirms that variability in insurance coverage exists for the indications of psoriasis and psoriatic arthritis.

Direct Comparison of Real-world Effectiveness of Biologics for Psoriasis using Absolute and Relative Psoriasis Area and Severity Index Scores in a Prospective Multicentre Cohort

Real-world evidence, directly comparing the effectiveness of interleukin (IL)17-inhibitors, IL23-inhibitors, tumour necrosis factor alpha (TNF-α)-inhibitors and an IL12/23-inhibitor in psoriasis, is scarce. The aim of this study was to directly compare the first-year effectiveness of biologic therapies for psoriasis, corrected for confounders. This prospective, multicentre cohort study assessed BioCAPTURE data on etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab, and guselkumab in 1,080 treatment episodes of 700 patients with psoriasis. The course of the mean absolute Psoriasis Area and Severity Index (PASI) and the proportion of patients who achieved PASI90/PASI75 were compared using linear mixed models and mixed logistic regression models respectively, corrected for baseline PASI, biologic naivety, and weight. Patients treated with adalimumab, ustekinumab, secukinumab, ixekizumab, or guselkumab all had a significantly lower mean PASI after 12 months compared with etanercept, and significantly higher overall odds of reaching PASI90 than those treated with etanercept. Patients treated with ixekizumab or guselkumab also had higher probabilities of reaching PASI90 than adalimumab, ustekinumab, and secukinumab. Relative to randomized controlled trials, the proportions of patients who reached PASI90/75 were lower in this real-world study.

Overlapping network meta-analyses on psoriasis systemic treatments: an overview, quantity does not make quality

BACKGROUND

Network Meta-analyses (NMAs) have become successful in addressing gaps in the comparative effectiveness of systemic treatments in moderate-to-severe psoriasis. However, their increasing number carries both a risk of overlap and reproducibility issues that can hamper clinical decision-making. In this overview, we aimed to assess redundancy across these NMAs and to describe their characteristics.

METHODS

We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of systemic treatments compared with placebo or with an active comparator. PubMed/MEDLINE, Epistemonikos, PROSPERO and the Evidence Update of the Centre of Evidence-Based Dermatology of the University of Nottingham were searched up to 25 February 2021. Our main outcome was the number per year of redundant NMAs and the extent of their overlap. We also described their features, especially, the confidence in the results of the reviews, the studies' funding and the presence of spin (a description that overstates efficacy and/or understates harm), reporting issues and methodological characteristics.

RESULTS

In total, 47 redundant NMAs were included. Only 2/47 (4%) included all available treatments. Both efficacy and safety were evaluated in 14/47 (30%) NMAs and both short and long-term evaluations were assessed in 5/47 (11 %). Confidence in the results was critically low for 39/47 (83%) NMAs and only 10/47 (23 %) registered a protocol. 26/47 NMAs (55%) received pharmaceutical funding. CROs were involved in 19/47 (40%) NMAs. Reporting was poor across most of the NMAs' abstracts and spin was present in all of the abstracts. Almost half of the NMA failed to consider important limitations such as heterogeneity (32%) or consistency (66%).

DISCUSSION

In addition to a duplication of efforts, our overview showed heterogeneous methods and poor confidence in the results in a majority of the included NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable and comprehensive evidence.