Biologics for pediatric moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis

Background and Objectives: To compare the efficacy and safety of biologic treatments for moderate-to-severe pediatric psoriasis approved by the US Food and Drug Administration and European Medicines Agency. Patients and Methods: MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs) were searched for the identification of eligible RCTs until May 7, 2021. Fixed-effect frequentist network meta-analysis (NMA) was performed with the surface under the cumulative ranking curve (SUCRA) calculated for ranking. Our primary outcomes included >= 90 % improvement of Psoriasis Area and Severity Index score (PASI 90) at 12-16 weeks and discontinuation owing to adverse events ( DAE) through the first 12-16 weeks. Results: Five RCTs involving 798 pediatric psoriasis patients were included. Compared to placebo, all biologic regimens exhibited a significantly higher PASI 90 response but did not differ in the risk for DAE. Based on the SUCRA, secukinumab-low dose (SEC-L) ranked first in the achieved PASI 90 response (84.7 %), followed by ixekizumab (70.8 %). Conclusions: Among all biologic treatments, SEC-L showed the best PASI 90 response without increasing the risk for DAE. More long-term studies are warranted.

Automated summary

This study compared the efficacy and safety of biologic treatments for pediatric psoriasis approved by the FDA and EMA. The results showed that biologic treatments were effective in improving PASI scores and had a low risk of adverse events. SEC-L showed the best response in terms of PASI improvement.