OBJECTIVES: This network meta-analysis (NMA) compares the relative efficacy of brodalumab to other biologic agents in the treatment of moderate-to-severe plaque psoriasis based on randomized controlled trials (RCTs) evidence.

METHODS: A systematic literature review of RCTs published to October 2017 was conducted to populate the NMA. Relevant comparators included were ixekizumab, secukinumab, infliximab, adalimumab, etanercept, ustekinumab, guselkumab, and placebo according to their doses approved by Health Canada. The primary efficacy outcome measure was the Psoriasis Area Severity Index (PASI) response. A random effects Bayesian multinomial likelihood and probit link model was used to analyze PASI 50, 75, 90, and 100 responses at the end of the induction period (10-16 weeks). Inconsistency and heterogeneity were assessed in the network. Sensitivity analyses were conducted to explore potential effect modifiers such as baseline PASI score, age, weight, Dermatology Life Quality Index score, duration of psoriasis, and prior biologics exposure.

RESULTS: A total of 43 RCTs were included in evidence network. The analysis showed that brodalumab 210mg had significantly better PASI response than ustekinumab, secukinumab, etanercept, adalimumab, and guselkumab and comparable PASI responses to infliximab and ixekizumab. Relative risk of PASI 75 response for brodalumab varied from 1.72 (1.54 to 1.96, p<0.05) to 0.99 (95%CI: 0.95 to 1.05, ns) when compared to etanercept and ixekizumab. This trend was similar across PASI 50, 90, and 100 outcomes, but a larger relative risk between brodalumab and all comparators except ixekizumab was observed for PASI 100 response. No significant heterogeneity or inconsistencies were identified and the results were consistent across all the sensitivity analyses, indicating robustness of the results.

CONCLUSIONS: Based on the findings of this NMA, brodalumab 210 mg can be considered a superior alternative to most biologic agents currently used for the treatment of moderate-to-severe plaque psoriasis.