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Ustekinumab more effective than some biological agents as psoriasis therapy

Ustekinumab appeared to be more effective than adalimumab, etanercept and alefacept but not infliximab in treating moderate to severe plaque psoriasis, according to study results.

Researchers conducted a systemic search of MEDLINE (PubMed), Embase, the Cochrane Library and clinicaltrials.gov from Jan. 31, 1992 to Feb. 1, 2012 for randomized controlled trials of biological agents comparing placebo or other biological agents using the Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis. Trial size, follow-up period, patients’ age range, disease duration, body surface area involvement, baseline PASI, PASI response and previous treatment with biological agents were extracted.

Using three regression models, researchers performed a Bayesian network meta-analysis and determined that a random-effects model was most effective for data. Seventeen studies were selected (mean age range of patients, 41 to 47 years). Using Jadad scoring, four randomized control trials (RCTs) received a score of 3, eight RCTs had scores of 4, and five had scores of 5. Ustekinumab use was associated with statistically significantly higher odds for achieving a 75% reduction in the PASI compared with adalimumab use (OR=1.84; 95% credible interval [CrI], 1.01-3.45), alefacept use (OR=10.38; 95% CrI, 3.44-27.62) and etanercept use (OR=2.07; 95% CrI, 1.42-3.06) but with lower odds compared with infliximab use (OR=0.36; 95% CrI, 0.14-0.82). Interleukin-12/23 (IL-12/23) inhibitor had the highest odds for a 75% reduction achievement in PASI compared with placebo (OR=69.48; 95% CrI, 36.89-136.46) in assessing therapeutic class, followed by tumor necrosis factor inhibitors (OR=42.22; 95% CrI, 27.94-69.34).

“The use of a Bayesian network meta-analysis enabled us to compare the efficacy of ustekinumab with that of other biological agents using PASI responses as the outcome among adult patients with moderate to severe plaque psoriasis during the induction phase … ,” the researchers concluded. “Ustekinumab, the newest agent that targets IL-12/23, seems to be more efficacious than adalimumab, etanercept and alefacept but not infliximab.”

Disclosure: See the study for a full list of relevant disclosures.