The purpose of the study was to compare the short-term and long-term safety and benefit-risk profiles of the therapies for moderate-to-severe psoriasis.

This was a systematic literature review of phase II-IV randomized controlled trials (RCTs) of patients with moderate-to-severe psoriasis. The adverse events (AEs) of treatments administered were compared using Bayesian network meta-analyses (NMAs).

The short-term NMA (involving 12-16 weeks of treatment) included 52 RCTs – the rate of AEs was the lowest for tildrakizumab, certolizumab and etanercept. While the rate of serious AEs was the lowest for certolizumab, risankizumab and etanercept. The least number of treatment discontinuation due to AE were documented in risankizumab, tildrakizumab and guselkumab. 

The long-term NMA (involving 48-56 weeks of treatment) included 7 RCTs, wherein, risankizumab showed the lowest AE rates of all 3 outcomes. This drug had the most favorable benefit-risk profile.

It was inferred that in the short-term, anti-interleukin 23 agents – guselkumab, risankizumab and tildrakizumab, were associated with the lowest rates AEs. Whereas, risankizumab appeared to be the safest drug for long-term use. 

Source: Shear NH, Betts KA, Soliman AM, et al. Comparative safety and benefit-risk profile of biologics and oral treatment for moderate-to-severe plaque psoriasis: A network meta-analysis of clinical trial data. J Am Acad Dermatol. 2021;85(3):572-81.