Conflict of interest AN has received honoraria for presenting at independent CME certified educational events, that received indirect or direct financial support from pharmaceutical industry, including Abbot, Pfizer/Wyeth, Janssen-Cilag. In addition AN received honoraria for participation in independent research projects, that were financed by unrestricted grants by Pfizer/Wyeth and Abbot. Independent CME-certified educational talks for Abbott, Biogen, Janssen-Cilag, MSD, and Pfizer. JS served as a paid consultant for Abbott and Novarits, and received research funding from Novartis and Wyeth.
Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment
Article first published online: 9 MAR 2012
© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 26, Issue 11, pages 1331–1344, November 2012
How to Cite
Lucka, T.C., Pathirana, D., Sammain, A., Bachmann, F., Rosumeck, S., Erdmann, R., Schmitt, J., Orawa, H., Rzany, B. and Nast, A. (2012), Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment. Journal of the European Academy of Dermatology and Venereology, 26: 1331–1344. doi: 10.1111/j.1468-3083.2012.04492.x
Funding sources This study was funded by an unrestricted grant from Wyeth Pharma, Münster, Germany. The sponsor had no influence on the development of the review. Wyeth Pharma as well as Biogen Idec sponsored with separate unrestricted grands the ‘Stiftungsprofessur für Evidenzbasierte Medizin in der Dermatologie’ for BR.
- Issue published online: 16 OCT 2012
- Article first published online: 9 MAR 2012
- Received: 24 October 2011; Accepted: 1 February 2012
Background Despite the chronicity of psoriasis, most systematic reviews focus on short-term treatment.
Methods The systematic search strategy and results from the German Psoriasis Guidelines were adapted. To update the data a literature search in Medline, Embase and the Cochrane Library was conducted. The proportion of participants achieving ≥75% decrease in Psoriasis Area and Severity Index (PASI) as well as Dermatology Life Quality Index (DLQI) reduction at different time points were assessed. Trials were summarized with respect to time periods and study designs. Suitable trials were included in a meta-analysis. Particular attention was paid to statistical approaches of handling dropouts.
Results A total of 33 articles including 27 trials totaling 6575 patients with active treatment were included in the systematic review. Seven randomized controlled trials were eligible for the meta-analysis. Over a 24 week treatment period infliximab [risk difference (RD) 78%, 95% confidence interval (CI) 72–83%] and ustekinumab 90 mg every 12 weeks (RD 77%, 95% CI 71–83%) were the most efficacious treatments. Adalimumab (RD: 60%, 95% CI 45–74%) showed results within the range of different etanercept dosages (etanercept 50 mg once weekly: RD 62%, 95% CI, 52–72%), (etanercept 25 mg twice weekly: RD 45%, 95% CI 34–56%), (etanercept 50 mg twice weekly: RD 56%, 95% CI 49–62%) and (etanercept 50 mg twice weekly until week 12, then 25 mg twice weekly: RD 50%, 95% CI 42–57%). After 24 weeks a decrease in efficacy for inflximab, adalimumab and etanercept was observed.
Conclusions More sufficient data is required to draw reliable conclusions in extended long-term treatment and head-to-head comparisons are necessary.