Plaque psoriasis: safety and efficacy of interleukin-23p19 blockers

Takeaway

• Interleukin (IL)-23p19 blockers (IL-23p19: risankizumab, tildrakizumab and guselkumab) demonstrated good efficacy and safety in patients with plaque psoriasis and had better efficacy than other inhibitors such as adalimumab and ustekinumab without other adverse events (AEs).

Why this matters

• Findings call for future trials to determine the long-term safety and the maintenance of efficacy.

Study design

• Systematic review and meta-analysis of 13 randomised controlled trials (RCTs) included 5155 patients with plaque psoriasis.
• 3190 patients were treated with IL-23p19 blockers, and 1965 with controls (placebo, n=1101; adalimumab, n=625; and ustekinumab, n=239)
• Funding: The National Natural Science Foundation of China.

Key results

• Efficacy:
  • IL-23p19 blockers vs placebo:
    • Psoriasis Area Severity Index (PASI) score reductions from baseline of ≥75% (relative risk [RR], 11.469; 95% CI, 9.441-13.934);
    • Static Physician's Global Assessment score (sPGA) of 0 or 1 (RR, 11.327; 95% CI, 9.251-13.868).
  • IL-23p19 blockers vs adalimumab:
    • PASI reductions from baseline of ≥100 (PASI100; RR, 1.851; 95% CI, 1.538-2.229);
    • PASI reductions from baseline of ≥90% (RR, 1.480; 95% CI, 1.348-1.624);
    • PASI75 (RR, 1.246; 95% CI, 1.177-1.318);
    • Dermatology Life Quality Index score 0/1 (RR, 1.398; 95% CI, 1.242-1.575).
  • IL-23p19 blockers vs ustekinumab:
    • PASI100 (RR, 2.430; 95% CI, 1.828-3.229);
    • PASI90 (RR, 1.539; 95% CI, 1.327-1.786);
    • PASI75 (RR, 1.252; 95% CI, 1.146-1.368); and
    • Spga 0/1 (RR, 1.286; 95% CI, 1.162-1.422).
• IL-23p19 blockers had similar safety vs placebo in terms of incidence of AEs (RR, 1.22; P=.096) and serious AEs (RR, 2.93; P=.965).
• Incidences of infections were more with IL-23p19 blockers vs placebo (RR, 1.387; 95% CI, 1.160-1.659).

Limitations

• Small sample size in some studies.