Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year

Figures & data

Figure 1. PRISMA flow diagram of SLR and NMA.

Figure 2. Network diagram of PASI responses - analysis 1 and analysis 2.

ADA: adalimumab; APR: apremilast; BRO: brodalumab; CZP: certolizumab pegol; ETN: etanercept; GUS: guselkumab; INF: infliximab; IXE: ixekizumab; PBO: placebo; SEC: secukinumab; RIS: risankizumab; UST WBD: ustekinumab weight-based dose.

Table 1. Baseline characteristics of studies included in the primary analysis and the secondary analysis.

Study, publications	Treatment	Sample size		Age (years)		Male	Weight (kg)		PsA	Disease duration (years)		Previous therapies			Percentage psoriasis affected BSA		PASI score		DLQI score
		Ind.	Main.									Phototherapy (UVB or PUVA)	Systemic non-biologic	Biologic
		n	n	Mean	SD	%	Mean	SD	%	Mean	SD	%	%	%	Mean	SD	Mean	SD	Mean	SD
Analysis 1 studies
AMAGINE-2 (39)	Brodalumab 210mg	612	168	45	13	69%	91	23	19%	19	12	52%	77%	29%	26	16	20.3	8.3	14.7	7.1
	Ustekinumab (WBD)	300	289	45	13	68%	91	24	17%	19	13	50%	75%	28%	27	19	20	8.4	15.1	7.2
AMAGINE-3 (39)	Brodalumab 210mg	624	171	45	13	69%	90	23	20%	18	12	40%	68%	25%	28	18	20.4	8.3	14.5	7.2
	Ustekinumab (WBD)	313	301	45	13	68%	90	22	20%	18	12	44%	70%	24%	28	18	20.1	8.4	14.6	7.4
IXORA-S (17)	Ixekizumab 80 mg Q2W	136	136	42.7	12.7	66%	85.8	20.3		18	11.1	60%	93%	13%	27	17	19.9	8.2	11.1	7.2
	Ustekinumab (WBD)	166	166	44	13.3	68%	89.4	24.8		18.2	12	61%	92%	15%	28	17	19.8	9	12	7.3
ultIMMa-1 (40)	Risankizumab 150mg	304	304	48.3	13.4	70%	87.8	22.9	28%					34%	26	15	20.6	7.7	13	7
	Ustekinumab (WBD)	100	100	46.5	13.4	70%	88.9	22.9	23%					30%	25	15	20.1	6.8	13.6	7.3
ultIMMa-2 (40)	Risankizumab 150mg	294	294	46.2	13.7	69%	92.2	21.7	25%					40%	26	16	20.5	7.8	13.5	7.4
	Ustekinumab (WBD)	99	99	48.6	14.8	67%	91.9	21.4	27%					43%	21	12	18.2	5.9	11.7	6.6
CLEAR (41)	Secukinumab 300mg	337	334	45.2	14	68%	87.4	20	21%	19.6	12.9		65%	14%	33	18	21.7	8.5
	Ustekinumab (WBD)	339	335	44.6	13.7	74%	87.2	22.1	16%	16.1	11.2		66%	13%	32	17	21.5	8.1
FIXTURE (42)	Etanercept 50mg BIW	326	323	43.8	13	71%	84.6	20.5	14%	16.4	12		63%	14%	34	18	23.2	9.8	13.4
	Secukinumab 300mg	327	323	44.5	13.2	69%	83	21.6	15%	15.8	12.3		60%	12%	34	19	23.9	9.9	13.3
VOYAGE 1 (43)	Adalimumab 40mg Q2W	334	334	42.9	12.6	75%			19%	17	11.3	54%	64%	21%	29	17	22.4	9	14.4	7.3
	Guselkumab 100 mg	329	329	43.9	12.7	73%			20%	17.9	12.3	57%	64%	22%	28	17	22.1	9.5	14	7.5
ECLIPSE (44)	Guselkumab 100 mg	534	534	46.3	13.7	68%			18%			53%	52%	29%			20	7.4
	Secukinumab 300mg	514	514	45.3	13.6	65%			15%			51%	56%	29%			20.1	7.6
Analysis 2 studies
Gordon 2006 (45)	Placebo	52	52	43	20–70	65%	94	50–147	31%	19	1-40				28	7-75	16	5.5–40.4	12.2	8.1
	Adalimumab 40mg Q2W	46	35	46	20–71	71%	93	63–159	33%	21	1-58				29	6-58	16.7	5.4–39.0	13.3	8.8
X-PLORE (46)	Placebo	42	42	46.5		67%	93.6	22.6	29%	18	13.3	50%	50%	36%	28	19	21.8	10
	Adalimumab 40mg Q2W	43	38	50		70%	91.6	19.9	26%	19.3	12.8	56%	40%	60%	27	17	20.2	7.6
Ohtsuki 2017 (47)	Placebo	84	84	48.3	12	74%	68.5	13.8		12.4	9.4		26%	5%	28	15	19.9	8.9	7.5	5.3
	Apremilast 30mg BID	85	85	51.7	12.7	84%	70.1	13		13.9	9.2		31%	2%	31	16	21.6	8.9	7.4	5.7
LIBERATE (48)	Placebo	84	84	43.4	14.9	70%	89.5	23.1		16.6	12.1		83%	0%	27	16	19.4	6.8	11.4	6.3
	Apremilast 30mg BID	83	74	46	13.6	59%	88.5	19.8		19.7	12.7		80%	0%	27	16	19.3	7	13.6	6.7
UNVEIL (49)	Placebo	73	73	51.1	13.7	56%	89.6	19.1		13.9	12.6		0%	0%	7	2	8	3.2	11.1	6.5
	Apremilast 30mg BID	148	148	48.6	15.4	50%	87.5	21.1		17.5	13.9		0%	0%	7	2	8.2	4	11	6.5
CIMPASI-1 (50)	Placebo	51	51	47.9	12.8	69%	95.2	19.5	8%	18.5	12.9			29%	26	16	19.8	7.5	13.9	8.3
	Certolizumab 200mg	95	95	44.5	13.1	71%	92.6	21	11%	16.6	12.3			32%	25	17	20.1	8.2	13.3	7.4
	Certolizumab 400mg	88	88	43.6	12.1	68%	92.2	21.7	17%	18.4	12.9			33%	24	17	19.6	7.9	13.1	6.5
CIMPASI-2 (50)	Placebo	49	49	43.3	14.5	53%	87.1	26.4	18%	15.4	12.2			29%	20	10	17.3	5.3	12.9	7.3
	Certolizumab 200mg	91	91	46.7	13.3	64%	97.8	25.6	24%	18.8	13.5			35%	21	12	18.4	5.9	15.2	7.2
	Certolizumab 400mg	87	87	46.4	13.5	49%	91.8	27.7	30%	18.6	12.4			35%	23	12	19.5	6.7	14.2	7.2
Tyring 2006 (51)	Placebo	309	306	45.6	12.1	70%	91		33%	19.7	11.4				27	17	18.1	7.4	12.5	6.7
	Etanercept 50mg BIW	311	304	45.8	12.8	65%	92.6		35%	20.1	12.3				27	18	18.3	7.6	12.1	6.7
Ohtsuki 2018 (52)	Placebo	64	64	48.3	10.6	84%	71.6	14	16%	13.7	10.2	42.20%	59%	16%	34	18	25.9	12.341	10.6	7.74
	Guselkumab 100mg	63	63	47.8	11.07	75%	74.3	16	16%	14.4	9.2	47.60%	59%	18%	38	21	26.7	12.196	10.3	7.27
EXPRESS (53)	Placebo	77	77	43.8	12.6	79%	89.3	18.7	29%	17.3	11.1	71%	46%		34	18	22.8	8.7	11.8	7.5
	Infliximab 5mg/kg	301	281	42.6	11.7	69%	85.9	20.1	31%	19.1	11	65%	42%		34	19	22.9	9.3	12.7	7
EXPRESS II (54)	Placebo	208	208	44.4	12.5	69%	91.1	22.6	26%			50%		13%	28	18	19.8	7.7	13.4	7.3
	Infliximab 5mg/kg	314	134	44.5	13	65%	92.2	23.2	28%			55%		14%	29	16	20.4	7.5	13.1	7
Torii 2010 (55)	Placebo	19	19	43.3	12.3	74%	69.7	8.9	37%	11.1	6.4	74%	95%		50	27	33.1	15.6	10.5	6.8
	Infliximab 5mg/kg	35	32	46.9	13	63%	68.5	13.4	29%	14.2	8.9	63%	94%		46	21	31.9	12.8	12.7	6.8
UNCOVER-3 (23)	Placebo	193	193	46	12	71%	91	21		18	13	31%	43%	17%	29	17	21	8	13	7
	Ixekizumab 80mg Q2W	385	362	46	13	66%	90	23		18	12	39%	44%	15%	28	17	21	8	12	7
SUSTAImm (56)	Placebo	58	54	50.9	11.2	78%	75.1	17.7	12%					24%	33	19	24	9.4	9.7	5.8
	Risankizumab 150mg	55	54	53.3	11.9	91%	74.1	16.2	9%					29%	41	23	26.3	11.7	10.4	5.4
FEATURE (57)	Placebo	59	59	46.5	14.1	66%	88.4	21.6		20.2	14.2		49%	44%			21.1	8.5
	Secukinumab 300mg	59	58	45.1	12.6	64%	92.6	25.9		18	11.9		34%	39%	33	18	20.7	8
ERASURE (42)	Placebo	248	246	45.4	12.6	69%	89.7	25	27%	17.3	12.4		44%	29%	30	16	21.4	9.1	12
	Secukinumab 300mg	245	245	44.9	13.5	69%	88.8	24	23%	17.4	11.1		52%	29%	33	19	22.5	9.2	13.9
JUNCTURE (58)	Placebo	61	61	43.7	12.7	62%	90.2	21.2	20%	19.9	12.2		48%	21%	26	15	19.4	6.7
	Secukinumab 300mg	60	60	46.6	14.2	77%	91	23.1	23%	21	13.5		50%	25%	26	13	18.9	6.4
PHOENIX 1 (59)	Placebo	255	255	44.8	11.3	72%	94.2	23.5	35%	20.4	11.7	59%	56%	50%	28	17	20.4	8.6	11.8	7.4
	Ustekinumab 45mg	255	251	44.8	12.5	69%	93.7	23.8	29%	19.7	11.7	68%	55%	53%	27	18	20.5	8.6	11.1	7.1
	Ustekinumab 90mg	256	246	46.2	11.3	68%	93.8	23.9	37%	19.6	11.1	67%	55%	51%	25	15	19.7	7.6	11.6	6.9
Igarashi 2012 (60)	Placebo	32	31	49		84%	71.2	10.9	3%	16	11.2	63%	66%	0%	50	23	30.3	11.8	10.5	6.2
	Ustekinumab 45mg	64	60	45		83%	73.2	15.4	9%	15.8	8.2	56%	73%	2%	47	24	30.1	12.9	11.4	6.5
	Ustekinumab 90mg	62	56	44		76%	71.1	14	11%	17.3	10.7	82%	84%	0%	47	20	28.7	11.2	10.7	6.4

BID: twice daily; BIW: twice weekly; BSA: body surface area; DLQI: dermatology life quality index; Ind: induction; Maint: maintenance; PASI: psoriasis area and severity index; PsA: psoriatic arthritis; PUVA: psoralen and ultraviolet A; Q2W: every 2 weeks; Q4W: every 4 weeks; SD: standard deviation; UVB: ultraviolet B; WBD: weight-based dose.

Where standard deviation is not reported, range is presented.

Figure 3. Results of predicted percentage PASI 75, 90, and 100 responses for evaluated interventions (Analysis 1).

Q2W: every 2 weeks; Q4W: every 4 weeks; WBD: weight-based dose.

Figure 4. Analysis 1: Relative treatment effect for all interventions. Relative effects are plotted as the median difference in response on the probit scale, where positive values indicate greater efficacy for the intervention and negative values indicate greater efficacy for the comparator.

ADA: adalimumab; BRO: brodalumab; ETN: etanercept; GUS: guselkumab; IXE: ixekizumab; SEC: secukinumab; RIS: risankizumab; UST: ustekinumab weight-based dose.

Table 2. NMA of 52-week active therapy RCTs (Analysis 1): results for PASI response.

Intervention vs.	Comparator	Median risk ratio (95% credible interval)
		PASI 75	PASI 90	PASI 100
RIS	BRO	1.03 (0.99, 1.12)	1.05 (0.98, 1.2)	1.11 (0.96, 1.38)
	GUS	1.03 (0.98, 1.14)	1.06 (0.97, 1.24)	1.12 (0.94, 1.46)
	IXE	1.08 (1.01, 1.28)	1.15 (1.02, 1.47)	1.31 (1.05, 1.91)
	SEC	1.13 (1.04, 1.35)	1.23 (1.08, 1.59)	1.48 (1.18, 2.12)
	UST	1.29 (1.1, 1.69)	1.52 (1.2, 2.15)	2.1 (1.5, 3.28)
	ADA	1.33 (1.1, 1.95)	1.6 (1.2, 2.63)	2.28 (1.47, 4.44)
	ETN	1.65 (1.22, 2.76)	2.18 (1.43, 4.14)	3.66 (2.03, 8.26)
BRO	GUS	1 (0.94, 1.08)	1 (0.9, 1.14)	1.01 (0.82, 1.26)
	IXE	1.05 (0.98, 1.21)	1.09 (0.97, 1.34)	1.17 (0.94, 1.63)
	SEC	1.09 (1.02, 1.27)	1.16 (1.04, 1.44)	1.32 (1.09, 1.8)
	UST	1.25 (1.09, 1.57)	1.43 (1.18, 1.92)	1.87 (1.42, 2.71)
	ADA	1.29 (1.08, 1.83)	1.51 (1.17, 2.37)	2.04 (1.37, 3.76)
	ETN	1.59 (1.2, 2.57)	2.05 (1.39, 3.72)	3.27 (1.9, 6.92)
GUS	IXE	1.05 (0.97, 1.21)	1.08 (0.95, 1.35)	1.17 (0.9, 1.66)
	SEC	1.09 (1.03, 1.23)	1.16 (1.06, 1.36)	1.32 (1.14, 1.64)
	UST	1.24 (1.09, 1.58)	1.43 (1.17, 1.94)	1.85 (1.39, 2.78)
	ADA	1.29 (1.09, 1.75)	1.51 (1.19, 2.22)	2.04 (1.44, 3.33)
	ETN	1.59 (1.21, 2.51)	2.05 (1.4, 3.58)	3.26 (1.94, 6.49)
IXE	SEC	1.04 (0.94, 1.18)	1.06 (0.91, 1.29)	1.12 (0.84, 1.53)
	UST	1.18 (1.06, 1.44)	1.3 (1.11, 1.7)	1.57 (1.21, 2.27)
	ADA	1.22 (1.05, 1.67)	1.37 (1.08, 2.09)	1.72 (1.16, 3.08)
	ETN	1.51 (1.17, 2.34)	1.87 (1.32, 3.24)	2.75 (1.66, 5.62)
SEC	UST	1.13 (1.05, 1.32)	1.22 (1.08, 1.49)	1.4 (1.16, 1.83)
	ADA	1.18 (1.05, 1.5)	1.29 (1.09, 1.76)	1.53 (1.17, 2.33)
	ETN	1.46 (1.17, 2.09)	1.76 (1.31, 2.71)	2.46 (1.66, 4.2)
UST	ETN	1.04 (0.91, 1.26)	1.06 (0.86, 1.39)	1.09 (0.79, 1.64)
	ADA	1.27 (1.08, 1.73)	1.43 (1.13, 2.09)	1.74 (1.23, 2.86)
ADA	ETN	1.22 (1.04, 1.61)	1.34 (1.06, 1.92)	1.58 (1.09, 2.56)

ADA: adalimumab; BRO: brodalumab; ETN: etanercept; GUS: guselkumab; IXE: ixekizumab; PASI: psoriasis area and severity index; SEC: secukinumab; RIS: risankizumab; UST: ustekinumab weight-based dose.

Figure 5. Results of predicted percentage PASI 75, 90, and 100 responses for evaluated interventions (Analysis 2).

Q2W: every 2 weeks; Q4W: every 4 weeks; WBD: weight-based dose

Table 3. NMA of 52-week RCTs using induction phase placebo control (Analysis 2): results for PASI responses.

Intervention	Comparator	Median risk ratio (95% credible interval)
		PASI 75	PASI 90	PASI 100
RIS	BRO	1.02 (0.98, 1.11)	1.05 (0.97, 1.19)	1.1 (0.94, 1.36)
	GUS	1.02 (0.98, 1.12)	1.05 (0.96, 1.21)	1.1 (0.92, 1.4)
	IXE	1.07 (1.01, 1.24)	1.14 (1.02, 1.41)	1.28 (1.05, 1.76)
	SEC	1.11 (1.03, 1.31)	1.22 (1.07, 1.54)	1.44 (1.16, 2)
	INF	1.23 (1.05, 1.75)	1.43 (1.1, 2.34)	1.88 (1.22, 3.72)
	UST	1.28 (1.1, 1.68)	1.54 (1.22, 2.17)	2.11 (1.51, 3.26)
	CZP 400	1.28 (1.06, 1.96)	1.53 (1.12, 2.75)	2.1 (1.27, 4.69)
	ADA	1.32 (1.1, 1.89)	1.62 (1.21, 2.61)	2.28 (1.49, 4.27)
	CZP 200	1.45 (1.11, 2.47)	1.86 (1.24, 3.77)	2.82 (1.53, 7.2)
	ETN	1.59 (1.2, 2.54)	2.13 (1.42, 3.86)	3.47 (1.98, 7.29)
	APR	3.48 (1.78, 9.41)	6.29 (2.64, 20.56)	15.75 (5.2, 64.42)
	PBO	15.76 (5.08, 66.67)	42.09 (10.9, 213.49)	179.82 (36.9, 1104.12)
BRO	GUS	1 (0.94, 1.07)	1 (0.89, 1.13)	1 (0.82, 1.24)
	IXE	1.04 (0.99, 1.18)	1.08 (0.97, 1.3)	1.16 (0.95, 1.54)
	SEC	1.08 (1.02, 1.25)	1.16 (1.04, 1.42)	1.3 (1.08, 1.74)
	INF	1.19 (1.03, 1.66)	1.36 (1.06, 2.16)	1.7 (1.13, 3.25)
	UST	1.25 (1.09, 1.58)	1.46 (1.19, 1.97)	1.91 (1.43, 2.78)
	CZP 400	1.24 (1.04, 1.86)	1.45 (1.09, 2.54)	1.9 (1.18, 4.1)
	ADA	1.29 (1.09, 1.79)	1.53 (1.18, 2.38)	2.06 (1.39, 3.7)
	CZP 200	1.41 (1.1, 2.35)	1.76 (1.2, 3.47)	2.55 (1.42, 6.29)
	ETN	1.54 (1.19, 2.4)	2.02 (1.39, 3.52)	3.13 (1.87, 6.27)
	APR	3.39 (1.77, 8.91)	5.97 (2.58, 18.8)	14.23 (4.9, 55.35)
	PBO	15.34 (5.03, 62.62)	39.95 (10.67, 193.72)	162.5 (34.9, 941.62)
GUS	IXE	1.04 (0.99, 1.17)	1.08 (0.97, 1.29)	1.16 (0.95, 1.53)
	SEC	1.09 (1.03, 1.22)	1.16 (1.06, 1.36)	1.3 (1.13, 1.61)
	INF	1.19 (1.03, 1.64)	1.36 (1.07, 2.12)	1.7 (1.15, 3.16)
	UST	1.25 (1.09, 1.58)	1.46 (1.19, 1.99)	1.9 (1.42, 2.83)
	CZP 400	1.25 (1.04, 1.84)	1.45 (1.09, 2.49)	1.9 (1.19, 3.97)
	ADA	1.29 (1.09, 1.74)	1.54 (1.2, 2.25)	2.07 (1.46, 3.34)
	CZP 200	1.41 (1.1, 2.33)	1.76 (1.21, 3.41)	2.55 (1.44, 6.12)
	ETN	1.55 (1.19, 2.36)	2.02 (1.4, 3.42)	3.14 (1.91, 5.95)
	APR	3.39 (1.77, 8.78)	5.97 (2.59, 18.41)	14.23 (4.98, 53.46)
	PBO	15.34 (5.05, 62.07)	39.97 (10.73, 189.43)	162.79 (35.45, 905.8)
IXE	SEC	1.03 (0.97, 1.15)	1.06 (0.95, 1.24)	1.12 (0.91, 1.42)
	INF	1.14 (0.99, 1.52)	1.25 (0.99, 1.87)	1.46 (0.98, 2.6)
	UST	1.19 (1.07, 1.44)	1.33 (1.13, 1.73)	1.62 (1.27, 2.29)
	CZP 400	1.19 (1.01, 1.7)	1.33 (1.02, 2.2)	1.62 (1.03, 3.27)
	ADA	1.23 (1.06, 1.63)	1.4 (1.12, 2.06)	1.76 (1.25, 2.94)
	CZP 200	1.34 (1.07, 2.14)	1.61 (1.13, 3.01)	2.18 (1.26, 5.01)
	ETN	1.47 (1.17, 2.17)	1.85 (1.33, 3.02)	2.67 (1.71, 4.93)
	APR	3.23 (1.74, 8.04)	5.47 (2.48, 16.02)	12.14 (4.51, 43.15)
	PBO	14.63 (4.96, 56.27)	36.66 (10.33, 162.71)	138.93 (32.36, 720.46)
SEC	INF	1.1 (0.97, 1.42)	1.17 (0.94, 1.68)	1.31 (0.9, 2.2)
	UST	1.15 (1.05, 1.33)	1.25 (1.1, 1.53)	1.45 (1.2, 1.88)
	CZP 400	1.14 (0.98, 1.59)	1.25 (0.96, 1.98)	1.45 (0.94, 2.78)
	ADA	1.18 (1.05, 1.49)	1.32 (1.11, 1.79)	1.57 (1.21, 2.36)
	CZP 200	1.29 (1.05, 2)	1.51 (1.09, 2.71)	1.95 (1.16, 4.26)
	ETN	1.42 (1.15, 1.98)	1.74 (1.31, 2.61)	2.4 (1.65, 3.9)
	APR	3.11 (1.71, 7.42)	5.13 (2.4, 14.21)	10.85 (4.21, 35.91)
	PBO	14.11 (4.9, 51.81)	34.36 (10.03, 144.13)	124.07 (30.49, 593.47)
INF	UST	1.04 (0.85, 1.25)	1.06 (0.78, 1.41)	1.1 (0.69, 1.71)
	CZP 400	1.04 (0.82, 1.41)	1.07 (0.73, 1.67)	1.11 (0.61, 2.18)
	ADA	1.07 (0.88, 1.37)	1.11 (0.82, 1.6)	1.19 (0.74, 2.04)
	CZP 200	1.17 (0.91, 1.75)	1.28 (0.87, 2.24)	1.48 (0.8, 3.25)
	ETN	1.27 (1.05, 1.76)	1.45 (1.08, 2.25)	1.79 (1.14, 3.25)
	APR	2.79 (1.62, 6.26)	4.29 (2.15, 11.23)	8.12 (3.35, 25.98)
	PBO	12.68 (4.7, 42.63)	28.84 (9.22, 110.12)	92.94 (25.58, 407.83)
UST	CZP 400	1 (0.82, 1.32)	1 (0.74, 1.5)	1.01 (0.62, 1.83)
	ADA	1.03 (0.91, 1.23)	1.05 (0.87, 1.36)	1.09 (0.8, 1.57)
	CZP 200	1.13 (0.92, 1.64)	1.21 (0.87, 2.02)	1.34 (0.8, 2.75)
	ETN	1.23 (1.07, 1.59)	1.38 (1.12, 1.92)	1.64 (1.2, 2.52)
	APR	2.7 (1.59, 5.94)	4.06 (2.08, 10.3)	7.42 (3.17, 22.47)
	PBO	12.25 (4.6, 40.65)	27.22 (8.85, 101.5)	84.74 (23.74, 359)
CZP 400	ADA	1.03 (0.79, 1.32)	1.05 (0.7, 1.52)	1.08 (0.59, 1.91)
	CZP 200	1.12 (1, 1.39)	1.2 (1, 1.59)	1.33 (1, 1.95)
	ETN	1.22 (0.97, 1.68)	1.36 (0.96, 2.11)	1.61 (0.94, 2.99)
	APR	2.66 (1.58, 5.86)	3.99 (2.03, 10.25)	7.25 (3.01, 22.87)
	PBO	12.09 (4.6, 39.59)	26.75 (8.82, 99.6)	82.71 (23.47, 357.4)
ADA	CZP 200	1.09 (0.86, 1.57)	1.15 (0.79, 1.89)	1.24 (0.69, 2.52)
	ETN	1.19 (1.03, 1.51)	1.3 (1.05, 1.78)	1.5 (1.08, 2.29)
	APR	2.6 (1.57, 5.54)	3.83 (2.01, 9.36)	6.78 (2.98, 19.74)
	PBO	11.81 (4.55, 37.44)	25.72 (8.69, 90.91)	77.46 (22.82, 309.02)
CZP 200	ETN	1.08 (0.81, 1.45)	1.13 (0.74, 1.72)	1.21 (0.65, 2.22)
	APR	2.34 (1.45, 4.89)	3.29 (1.75, 8)	5.38 (2.3, 16.13)
	PBO	10.64 (4.33, 32.21)	21.97 (7.92, 75.13)	61.2 (19.11, 242.78)
ETN	APR	2.17 (1.41, 4.16)	2.92 (1.68, 6.32)	4.49 (2.19, 11.38)
	PBO	9.87 (4.19, 27.5)	19.6 (7.49, 59.56)	51.26 (17.54, 170.53)
APR	PBO	4.43 (2.54, 8.99)	6.52 (3.43, 14.47)	11.09 (5.16, 27.72)

ADA, adalimumab; APR, apremilast; BRO, brodalumab; CZP, certolizumab pegol; ETN, etanercept; GUS, guselkumab; INF, infliximab; IXE, ixekizumab; PASI, psoriasis area and severity index; PBO, placebo; SEC, secukinumab; RIS, risankizumab; UST, ustekinumab weight-based dose.

Figure 6. SUCRA and ranking with error bars indicating the 95% credible interval (Analysis 2).

ADA: adalimumab; BRO: brodalumab; ETN: etanercept; GUS: guselkumab; IXE: ixekizumab; SEC: secukinumab; RIS: risankizumab; UST: ustekinumab weight-based dose

Lebwohl M, Strober B, Menter A, et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med. 2015;373(14):1318–1328.

 PubMed Web of Science ®Google Scholar

Paul C, Griffiths CEM, van de Kerkhof PCM, et al. Ixekizumab provides superior efficacy compared with ustekinumab over 52 weeks of treatment: results from IXORA-S, a phase 3 study. J Am Acad Dermatol. 2019;80(1):70–79.e3.

 PubMed Web of Science ®Google Scholar

Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet (London, England). 2018;392(10148):650–661.

 PubMed Web of Science ®Google Scholar

Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: results from the CLEAR study. J Am Acad Dermatol. 2017;76(1):60–69.e9.

 PubMed Web of Science ®Google Scholar

Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis--results of two phase 3 trials. N Engl J Med. 2014;371(4):326–338.

 PubMed Web of Science ®Google Scholar

Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405–417.

 PubMed Web of Science ®Google Scholar

Reich K, Armstrong AW, Langley RG, et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial. Lancet (London, England). 2019;394(10201):831–839.

 PubMed Web of Science ®Google Scholar

Gordon KB, Langley RG, Leonardi C, et al. Clinical response to adalimumab treatment in patients with moderate to severe psoriasis: double-blind, randomized controlled trial and open-label extension study. J Am Acad Dermatol. 2006;55(4):598–606.

 PubMed Web of Science ®Google Scholar

Gordon KB, Duffin KC, Bissonnette R, et al. A phase 2 trial of guselkumab versus adalimumab for plaque psoriasis. N Engl J Med. 2015;373(2):136–144.

 PubMed Web of Science ®Google Scholar

Ohtsuki M, Okubo Y, Komine M, et al. Apremilast, an oral phosphodiesterase 4 inhibitor, in the treatment of Japanese patients with moderate to severe plaque psoriasis: efficacy, safety and tolerability results from a phase 2b randomized controlled trial. J Dermatol. 2017;44(8):873–884.

 PubMed Web of Science ®Google Scholar

Reich K, Gooderham M, Green L, et al. The efficacy and safety of apremilast, etanercept and placebo in patients with moderate-to-severe plaque psoriasis: 52-week results from a phase IIIb, randomized, placebo-controlled trial (LIBERATE). J Eur Acad Dermatol Venereol. 2017;31(3):507–517.

 PubMed Web of Science ®Google Scholar

Stein Gold L, Bagel J, Lebwohl M, et al. Efficacy and safety of apremilast in systemic- and biologic-naive patients with moderate plaque psoriasis: 52-week results of UNVEIL. J Drugs Dermatol. 2018;17(2):221–228.

 PubMed Web of Science ®Google Scholar

Gottlieb AB, Blauvelt A, Thaci D, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol. 2018;79(2):302–314.e6.

 PubMed Web of Science ®Google Scholar

Tyring S, Gottlieb A, Papp K, et al. Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebo-controlled randomised phase III trial. Lancet (London, England). 2006;367(9504):29–35.

 PubMed Web of Science ®Google Scholar

Ohtsuki M, Kubo H. Guselkumab, an anti-interleukin-23 monoclonal antibody, for the treatment of moderate to severe plaque-type psoriasis in Japanese patients: efficacy and safety results from a phase 3, randomized, double-blind, placebo-controlled study. J Dermatol. 2018;45(9):1053–1062.

 PubMed Web of Science ®Google Scholar

Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet (London, England). 2005;366(9494):1367–1374.

 PubMed Web of Science ®Google Scholar

Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol. 2007;56(1):31.e1–15.

 PubMed Web of Science ®Google Scholar

Torii H, Nakagawa H. Infliximab monotherapy in Japanese patients with moderate-to-severe plaque psoriasis and psoriatic arthritis. A randomized, double-blind, placebo-controlled multicenter trial. J Dermatol Sci. 2010;59(1):40–49.

 PubMed Web of Science ®Google Scholar

Griffiths CE, Reich K, Lebwohl M, et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet (London, England). 2015;386(9993):541–551.

 PubMed Web of Science ®Google Scholar

Ohtsuki M, Fujita H, Watanabe M, et al. Efficacy and safety of risankizumab in Japanese patients with moderate to severe plaque psoriasis: results from the SustaIMM phase 2/3 trial. J Dermatol. 2019;46(8):686–694.

 PubMed Web of Science ®Google Scholar

Blauvelt A, Prinz JC, Gottlieb AB, et al. Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol. 2015;172(2):484–493.

 PubMed Web of Science ®Google Scholar

Lacour JP, Paul C, Jazayeri S, et al. Secukinumab administration by autoinjector maintains reduction of plaque psoriasis severity over 52 weeks: results of the randomized controlled JUNCTURE trial. J Eur Acad Dermatol Venereol. 2017;31(5):847–856.

 PubMed Web of Science ®Google Scholar

Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet (London, England). 2008;371(9625):1665–1674.

 PubMed Web of Science ®Google Scholar

Igarashi A, Kato T, Kato M, et al. Efficacy and safety of ustekinumab in Japanese patients with moderate-to-severe plaque-type psoriasis: long-term results from a phase 2/3 clinical trial. J Dermatol. 2012;39(3):242–252.

 PubMed Web of Science ®Google Scholar