Efficacy of systemic treatments for moderate to severe plaque psoriasis: systematic review and meta-analysis.

Aims: To compare the efficacy of psoriasis treatments through a systematic literature review and meta-analysis.

Methods: Randomized controlled trials evaluating the Psoriasis Area and Severity Index (PASI) were identified and assessed for quality. PASI responses were modeled using a mixed-treatment comparison, which enabled the estimation of the relative effectiveness of several treatments. Sensitivity analyses were performed.

Results: Twenty-two trials were included. Tumor necrosis factor (TNF) inhibitors were most likely to achieve PASI 75, with a mean relative risk (RR) of 15.57 (95% CI 12.46-19.25) versus mean RRs of 9.24 (95% CI 5.33-13.91) for systemic and 5.65 (95% CI 3.74-7.97) for T-cell therapies. Infliximab (81%) and adalimumab (71%) had greater probabilities of achieving PASI 75 than etanercept (50%). Dosage was an important determinant of outcome.

Conclusions: TNF inhibitors were more effective than T cell agents; adalimumab and infliximab were more effective than systemic therapies and etanercept. Evidence-based comparisons support patient and physician decisions.