Objective:

To evaluate the efficacy and safety of systemic pharmacologic treatments for moderate to severe plaque psoriasis during the induction phase.

Approach:

Key Findings:

• IL-17 inhibitors ranked highest for efficacy, followed by IL-23, IL-12/23, and TNF inhibitors.
• All systemic therapies were more effective than placebo in achieving PASI 90.
• Infliximab, bimekizumab, ixekizumab, brodalumab, and risankizumab ranked highest for PASI 90 response.
• Serious adverse events were uncommon with no significant differences between treatments and placebo.
• Differences in onset of action were noted, with IL-17 inhibitors showing more rapid responses.

Interpretation:

Biologic therapies, especially IL-17 and IL-23 inhibitors, are the most effective options for short-term skin clearance in moderate to severe plaque psoriasis.

Limitations:

• Focus on short-term outcomes may not reflect long-term safety and effectiveness.
• Reporting of serious adverse events was infrequent and may not fully capture overall tolerability.

Conclusion:

The findings support the use of IL-17 and IL-23 inhibitors in reshaping expectations for psoriasis disease control.

Sources:

• JAMA Network
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