OBJECTIVES: To update the existing systematic review and network meta-analysis comparing the efficacy of targeted drugs in adults with moderate-to-severe plaque psoriasis by adding randomized clinical trials (RCTs) on a new interleukin (IL)-23 inhibitor recently approved in the Russian Federation – risankizumab, and other RCTs published after 2019.

METHODS: We updated our systematic literature search in PubMed/MEDLINE and Embase databases. Evidence synthesis included RCTs evaluating the efficacy of adalimumab (ADA), infliximab (INF), etanercept (ETN), certolizumab pegol (CZP), ixekizumab (IXE), netakimab (NTK), secukinumab (SEC), risankizumab (RIS), guselkumab (GUS), ustekinumab (UST), tofacitinib (TOFA), and apremilast (APR) after 12 weeks of therapy. The Bayesian meta-analyses with meta-regression accounted for high heterogeneity in patient characteristics and significant differences in the placebo response rates. The considered drugs were ranked based on values of surface under the cumulative ranking curve. Additionally, drug class analyses were carried out.

RESULTS: Twenty-three new RCTs were added to the network. IL-23 inhibitor RIS, recently approved in Russia, has joined the group of the most efficacious drugs, such as IL-17 inhibitors NTK and IXE, as well as IL-23 inhibitor GUS. In terms of PASI 75, RIS and IXE showed superiority compared to tumor necrosis factor-alpha (TNFα) inhibitors (INF, ADA, ETN), small molecules (TOFA and APR), and IL-12/23 inhibitor UST, while NTK and GUS were characterized by comparable efficacy with INF and outperformed the remaining drugs. There were no statistically significant differences between all the TNFα inhibitors.

CONCLUSIONS: The addition of head-to-head trials and increased statistical power of the network revealed previously unidentified significant differences between treatment options for moderate-to-severe plaque psoriasis.