OBJECTIVE

To assess comparative efficacy of biologics and targeted synthetic disease-modifying antirheumatic drugs approved in Russia to treat adults with active psoriatic arthritis using the systematic review of randomized clinical trials and network meta-analysis.

MATERIAL AND METHODS

The systematic review included the randomized clinical trials of biologics (adalimumab, golimumab, guselkumab, ixekizumab, infliximab, netakimab, secukinumab, ustekinumab, certolizumab pegol, etanercept) and targeted synthetic disease-modifying antirheumatic drugs (apremilast, tofacitinib) for the treatment of adults with active psoriatic arthritis. Efficacy was measured with ACR20/50/70, PASI 75/90, PsARC, MDA, LDI, LEI, and HAQ-DI after 16 and 24 weeks from treatment initiation. We performed the evidence synthesis using Bayesian approach. To take into account the significant heterogeneity in population characteristics and differences in placebo response rate between randomized clinical trials, we also constructed meta-regression models. Treatment options were ranked based on their SUCRA values (surface under the cumulative ranking curve). Additionaly, we performed analysis by class of biologics and targeted synthetic disease-modifying antirheumatic drugs, several sensitivity analyses, and subanalysis in biologic-naive population.

RESULTS

Biologics demonstrated superiority over targeted synthetic disease-modifying antirheumatic drugs («small molecules»). IL-17 inhibitors showed the highest mean scores, and netakimab dominated in all outcomes. TNF-a inhibitors were characterized by higher efficacy in archieving the ACR20/50/70 endpoints, while IL-17, IL-23 and IL-12/23 inhibitors — in PASI 75/90 endpoints. Some heterogeneity in within-class results was identified.

CONCLUSION

An individual approach in choosing treatment strategy based on clinical picture and features of certain biologics and targeted synthetic disease-modifying antirheumatic drugs is required.