Efficacy and Safety of Biologic Therapies for Treatment of Psoriasis: A Systematic Review and Observational Meta-Analysis

Abstract Background Psoriasis is a chronic, systemic, immune-mediated inflammatory skin disease of unknown etiology, however, several cytokines were reported to share in the pathogenesis of psoriasis as IL-12, IL- 23 and TNF-α. Biologics targeting these cytokines showed effective results in treatment of psoriasis patients. However, long term efficacy and tolerability of these agents is still questionable. Objective To compare the efficacy and safety of anti-TNF alpha, anti IL12/23, anti IL17, anti IL23 in moderate to severe psoriasis over long periods of treatment in order to complete the efficacy and safety profile of biologic therapies. Patients and Methods We searched ClinicalTrials.gov register (www.clinicaltrials.gov) up to July 2022 with the following search terms: psoriasis AND one by one each biologic therapy name listed in types of interventions. Results Regarding rate of PASI 75 at year 1, IL-12/23 inhibitors have a greater probability of achieving a PASI 75 response than anti-TNF alpha, with the pooled PASI 75 estimate at 84% and 76.18%, respectively. While, regarding rate of PASI 75 at year 2, 3, 4 and 5, there are no studies that assess the PASI 75 at year 2 or more for anti-TNF. The PASI 75 at years 2, 3, and 5 for IL- 12/23 inhibitors appeared to be stable at about 80 %, while it reached 91% at year 4. Rate of serious infections was 2.9% and 2.4% with anti-TNF alpha and IL-12/23 inhibitors respectively. There was showing no significant difference in the risk of serious infection between the two classes. In the current study, the rate of malignancy showed no-significant difference in psoriatic patients as patients receiving anti-TNF-alpha had 3.7% rate while in patients receiving IL 12/23 inhibitors the rate was 3.9%. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023. Conclusion In the current meta-analysis we compare the efficacy and safety of anti-TNF alpha and anti IL12/23 in moderate to severe psoriasis over long periods of treatment in order to complete the efficacy and safety profile of biologic therapies. IL-12/23 inhibitors have a greater probability of achieving a PASI 75 response than anti-TNF alpha. There was no significant difference in the risk of serious infection or rate of malignancy between the two classes. Moreover, there was insignificant risk of MACEs with IL12/23 inhibitors and a slight increased risk with anti-TNF alpha. There was significant rate of common adverse events in patients receiving anti-TNF-alpha compared to patients receiving IL 12/23 inhibitors.