BACKGROUND:

Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease often developing in patients with cutaneous psoriasis. Disease-modifying antirheumatic drugs (DMARDs) can slow the progression of PsA and save the joints from permanent damage. Many synthetic and biologic DMARDs are approved for the treatment of PsA in Russia, however, only few studies directly compare their clinical efficacy. Therefore, network meta-analysis (NMA) can inform evidence-based decision-making.

OBJECTIVES:

To compare the efficacy of synthetic DMARDs (sDMARDs) and biologic DMARDs (bDMARDs) approved in Russia for active PsA.

METHODS:

Phase II and III randomised controlled trials (RCTs) evaluating efficacy of sDMARDS (tofacitinib, apremilast) and bDMARDS (netakimab, guselkumab, ustekinumab, secukinumab, ixekizumab, adalimumab, etanercept, infliximab, certolizumab, golimumab) for active PsA were identified by systematic literature review performed in Pubmed and Embase databases. The risk of bias assessment of eligible RCTs and the assessment of possible sources of heterogeneity were conducted. Bayesian random effects NMAs were performed to estimate pooled risk ratios (RR) and 95% credible intervals (CIs) to compare and rank these treatments according to American College of Rheumatology criteria (ACR), ACR20, and 75% improvement in psoriasis area and severity index (PASI75) at weeks 16 and 24. Subgroup analyses included biologic-naïve population.

RESULTS:

Overall, 29 RCTs, including 10,894 participants, were selected for further synthesis.

Netakimab demonstrated significantly higher efficacy (ACR20) than other DMARDs at week 24, and at week 16 - along with infliximab and etanercept. No significant differences were established in PASI75.

In the overall population and biologic-naïve subgroup netakimab was ranked the highest for the ACR20 response rate both at weeks 16 and 24 analyses. Netakimab is also the most effective drug according to PASI75 in all NMAs conducted, except analysis at week 24 in the overall population where adalimumab dominates the ranking.

CONCLUSIONS:

Netakimab is one of the most effective treatments for active PsA.