medwireNews: Findings from a systematic review and network meta-analysis (NMA) suggest that different biologics have similar efficacy for the joint manifestations of psoriatic arthritis (PsA), but interleukin (IL)-17A-targeted therapies or guselkumab may be the best choice for skin responses.
The NMA included a total of 46 randomized controlled trials evaluating biologics or Janus kinase inhibitors for active PsA, the majority of which included placebo as a comparator.
Laura Sawyer (Symmetron Limited, London, UK) report in RMD Open that most agents “were better than placebo and similar to one another” for the outcomes of ACR response, PASI response, and resolution of enthesitis and dactylitis.
However, some differences were seen for PASI response, with the IL-23 inhibitor guselkumab associated with the greatest efficacy versus placebo, followed by the IL-17A receptor inhibitor brodalumab and the IL-17A inhibitors ixekizumab and secukinumab. The IL-17- and IL-23-targeted therapies also showed the greatest efficacy for resolution of dactylitis, followed by adalimumab and ustekinumab.
The researchers say that the licensed oral therapies included in the NMA – tofacitinib and apremilast – had “smaller effect sizes than most biological therapies” for PASI response.
“Faced with a multitude of therapeutic options, these study results could help clinicians tailor treatment choice according to different domains of disease and provides additional evidence for developing patient-centred treatment guidelines,” conclude Sawyer and team.
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