Biologic and Non-Biologic Therapies for Scalp Psoriasis: A Network Meta-analysis of Randomized Controlled Trials
Keywords:
Scalp psoriasis, Comparative Effectiveness, Biologics, Network Meta AnalysisAbstract
Introduction: Scalp psoriasis affects up to 80% of patients with plaque-type psoriasis and is often resistant to topical and conventional systemic agents. There is a lack of consensus on a “gold standard” treatment.
Objective: This comprehensive review and network meta-analysis aims to compare the efficacy and safety of studied interventions.
Methods: The Ovid MEDLINE(R), Embase, and Cochrane databases were searched from January 1, 2000, to October 5, 2022. All English-language randomized controlled trials evaluating an intervention for scalp psoriasis were included if they reported one of the following clinical outcomes: PSSI, IGA, ScPGA, mPASI, TSS, and adverse events. A random effects network meta-analysis was performed where possible, and network plots were generated.
Results: Of 1,046 studies identified, 35 met the inclusion criteria, with 7 in the PSSI analysis, and 16 in the IGA analysis. All interventions led to an improvement in all outcomes when compared to placebo in the PSSI and PGA/IGA. For the PSSI response, secukinumab 300 mg every 4 weeks (q4w) was the most effective (SUCRA 0.991). For the PGA/IGA response, bimekizumab 320 mg q4w was the most effective (SUCRA 0.975).
Conclusions: Several systemic therapies are superior to placebo in improving clinical outcomes, with secukinumab 300 mg q4w and bimekizumab 320 mg q4w deemed the most effective among biologic agents analyzed. Efforts to enhance research standardization, including head-to-head trials with standardized outcome measures, diverse patient recruitment, and long-term follow-up, are crucial next steps in assessing treatment efficacy and adverse events.
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