Guselkumab for the Treatment of Moderate-to-Severe Plaque Psoriasis During Induction Phase: A Systematic Review and Network Meta-Analysis. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Cameron, C.; Druchok, C.; Hutton, B.; McElligott, S.; Nair, S.; Schubert, A.; Situ, A.; Varu, A.; Villacorta, R.
• Is Part Of: Journal of psoriasis and psoriatic arthritis. Volume 4:Issue 2(2019)
• Page Start: 81
• Page End: 92
• Publication Date: 2019-04
• Subjects: systematic review -- network meta-analysis -- psoriasis -- biologic -- guselkumab; Psoriasis -- Periodicals; Psoriasis -- Treatment -- Periodicals; Psoriatic arthritis -- Periodicals; Psoriatic arthritis -- Treatment -- Periodicals; Electronic journals; 616.722
• DOI: 10.1177/2475530318818816
• Languages: English
• ISSNs: 2475-5303

Abstract

Background: Guselkumab is an interleukin-23 inhibitor indicated for treatment of moderate-to-severe plaque psoriasis. Objective: The objective was to determine the relative efficacy and safety of guselkumab compared to other biologics. Methods: A systematic review was performed to identify randomized controlled trials (RCTs). Bayesian network meta-analyses (NMAs) were conducted using meta-regression analyses that adjusted for cross-trial differences and risk differences. The primary outcome was Psoriasis Area and Severity Index (PASI) 90 response. Other efficacy and safety outcomes were considered. Several meta-regressions were performed to account for variations in patient and study characteristics: baseline risk adjustment (ie, control group response), prior biologic use, duration of psoriasis, weight, age, race, and baseline PASI/dermatology life quality index scores. The best-fitting model using predefined criteria was selected. Results: Forty-five RCTs were identified. Patient and study characteristics differed between RCTs as reflected in variations in control group response. Both the baseline risk-adjusted NMA and the risk-difference NMA fit the data best and suggested guselkumab has one of the highest PASI 90 responses. Pairwise comparisons from the baseline risk-adjusted PASI 90 NMA suggested guselkumab has comparable efficacy with ixekizumab (relative risk [RR]: 0.999, 95% credible intervals [CrIs]: 0.89-1.13) and brodalumab (RR: 1.04, 95% CrIs: 0.91-1.17) and superior efficacy versus all other treatments in the network (RR range, 1.20 to 43.22). Guselkumab was superior or comparable to other therapies for other efficacy outcomes and had a more favorable safety profile than most. Conclusions: Guselkumab has one of the highest PASI 90 responses among psoriasis treatments; similar findings were observed for other efficacy outcomes. Guselkumab has a favorable benefit–risk balance compared to moderate-to-severe psoriasis therapies.