OBJECTIVES: Psoriasis is a chronic, immune-mediated, inflammatory skin disease that negatively impacts patients’ health-related quality-of-life. Biologic medications have been developed and approved for the condition in recent years that have greatly improved patients’ care; however, little is known about their comparative efficacy. Our research objective was to synthesize and compare the efficacy of two of these new biologic treatments, ustekinumab and adalimumab.
METHODS: A literature review was conducted of randomized, controlled trials investigating the efficacy of ustekinumab (45 mg or 90 mg) and adalimumab (40mg) according to their approved FDA labels. As no head-to-head trials existed at the time of the study, a Bayesian network meta-analysis allowing for indirect comparisons was conducted on the ordered probit scale to evaluate comparative efficacy at a common week-12 time point based on the Psoriasis Area and Severity Index (PASI) 50, 75, 90, and 100 and the Physician’s Global Assessment (PGA) 0/1. The primary analysis was based on the intent-to-treat populations, and sensitivity analysis was conducted using the ustekinumab dose appropriate for patients’ body weight per the product label.
RESULTS: Seven clinical trials representing over 4,000 patients were included in the meta-analysis. The meta-analysis showed that PASI 50, 75, 90, and 100 response rates at week 12 were 76%, 55%, 29%, and 10% for adalimumab; 89%, 73%, 47%, and 20% for ustekinumab 45 mg; and 91%, 76%, 51%, and 24% for ustekinumab 90 mg, respectively. PGA 0/1 response rates at week 12 were 58%, 64%, and 69% for adalimumab, ustekinumab 45 mg, and ustekinumab 90 mg, respectively. Weight-based sensitivity analysis showed similar results between adalimumab and ustekinumab but higher efficacy for ustekinumab 45 mg in pts ≤100 kg compared with ustekinumab 90 mg in pts >100 kg per the label.
CONCLUSIONS: This network meta-analysis provides additional information about the comparative effectiveness of ustekinumab and adalimumab in treatment of moderate-to-severe PsO.
