BACKGROUND: Psoriasis is a chronic, non-communicable, inflammatory skin disease with an extensive emotional and psychological impact on patients. While multiple treatment options are available, biological therapy is the treatment of choice for patients with moderate-to-severe psoriasis not responding to other systemic therapies. Multiple randomised controlled trials (RCTs) have compared the efficacy of biologics to placebo. However, the relative effectiveness of these treatments is not straightforward due to the lack of head-to-head evidence.

OBJECTIVES: To compare the efficacy and safety of a new biologic netakimab and biologic agents approved and reimbursed in Russia (secukinumab, ustekinumab, infliximab, adalimumab, etanercept) in adults with moderate-to-severe plaque psoriasis.

METHODS: We performed the literature search in Pubmed database and Cochrane library, as well as in reference lists of original articles to identify publications of phase II, III, and IV RCTs evaluating the efficacy and safety of biologics for the treatment of moderate-to-severe psoriasis in adults. We assessed eligible RCTs for the risk of bias and possible sources of heterogeneity. Finally, we conducted a network meta-analysis using fixed effects model to synthesize evidence obtained from selected studies.

RESULTS: Overall, 20 articles were selected for quantitative and qualitative synthesis. Efficacy was determined by the proportion of patients achieving PASI75 at week 12 of the treatment. Safety was defined as the proportion of patients suffering at least one adverse event during the first 12 weeks of treatment. Network meta-analysis showed that netakimab is significantly more effective than adalimumab, etanercept, and ustekinumab, although there was no significant difference in efficacy between netakimab, secukinumab, and infliximab. In terms of safety, we found no statistically significant difference between all the interventions, except for etanercept, which was associated with lower safety profile.

CONCLUSIONS: Obtained results suggest that netakimab has efficacy superior to or comparable with other biologics and a similar safety profile.