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Original research
Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis
  1. Adeline Ruyssen-Witrand1,2,
  2. Richard Perry3,
  3. Clare Watkins4,
  4. George Braileanu3,
  5. Gayathri Kumar5,
  6. Sandeep Kiri6,
  7. Debby Nott6,
  8. Soyi Liu-Leage7,
  9. Susanne Hartz8 and
  10. Christophe Sapin9
  1. 1Rheumatology Center, Purpan Teaching Hospital, Toulouse, France
  2. 2Rheumatology Center, UMR 1027, Inserm, Paul Sabatier University Toulouse III, Toulouse, France
  3. 3Value Demonstration and Communication, Adelphi Values, Bollington, Cheshire, UK
  4. 4Statistical Consultancy, Clarostat Consulting Ltd, Alderley Edge, Cheshire, UK
  5. 5Health Economics & Pricing, Reimbursement and Access, Eli Lilly and Company Ltd, Basingstoke, UK
  6. 6Health Outcomes and Health Technology Assessment, Eli Lilly and Company Ltd, Basingstoke, UK
  7. 7International Business Unit—Rheumatology, Lilly France, Neuilly-sur-Seine, France
  8. 8Global Patient Outcomes and Real World Evidence International, Eli Lilly and Company, Windlesham, UK
  9. 9European Statistics, Lilly France, Neuilly-sur-Seine, France
  1. Correspondence to Richard Perry; richard.perry{at}


Background Biologic disease-modifying antirheumatic drugs (bDMARDs) and targeted synthetic DMARDs are used in patients with psoriatic arthritis (PsA), but few studies directly compare their clinical efficacy. In such situations, network meta-analysis (NMA) can inform evidence-based decision-making.

Objective To evaluate the comparative efficacy and safety of approved bDMARDs in patients with PsA.

Methods Bayesian NMA was conducted to compare the clinical efficacy of bDMARDs at weeks 12‒16 in bDMARD-naïve patients with PsA in terms of American College of Rheumatology (ACR) criteria, Psoriatic Arthritis Response Criteria (PsARC) and Psoriasis Area and Severity Index (PASI). Safety end points were evaluated in the overall mixed population of bDMARD-naive and bDMARD-experienced patients.

Results For ACR, all treatments except abatacept were statistically superior to placebo. Infliximab was most effective, followed by golimumab and etanercept, which were statistically superior to most other treatments. Ixekizumab 80 mg every 2 weeks (Q2W) was statistically superior to abatacept subcutaneous, apremilast and both regimens of ustekinumab; similar findings were observed for ixekizumab 80 mg Q4W. For PsARC response, ixekizumab did not significantly differ from other therapies, except for golimumab, infliximab and etanercept, which were superior to most other agents including ixekizumab. For PASI response, infliximab was numerically most effective, but was not statistically superior to ixekizumab, which was the next best performing agent. Analysis of safety end points identified few differences between treatments.

Conclusion Our NMA confirms the efficacy and acceptable safety profile of bDMARDs in patients with active PsA. There were generally few statistically significant differences between most treatments.

  • psoriatic arthritis
  • DMARDs (biologic)
  • DMARDs (synthetic)

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  • Contributors AR-W was involved with the interpretation of the data. RP and CW were involved with the design of the work, as well as the analysis and interpretation of the data. GB was involved with the design of the work, as well as the acquisition, analysis and interpretation of the data. GK and CS were involved with the design of the work and the interpretation of the data. SK, DN and SH were involved with the conception and design of the work, as well as the interpretation of the data. SL-L was involved with the conception of the work and the interpretation of the data. All authors contributed sufficiently to the work and provided critical revision of the manuscript for important intellectual content. All authors give their approval for the manuscript to be submitted and published in RMD Open and agree to be accountable for all aspects of the work.

  • Funding This study was funded by Eli Lilly and Company.

  • Competing interests AR-W has received honoraria for conferences and as a scientific expert from Abbvie, Amgen, Biogen, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB. RP and GB are full-time employees of Adelphi Values Ltd, and CW of their cooperation partner, Clarostat Consulting Ltd, who were commissioned by Eli Lilly and Company to conduct the analysis for this work. SL-L, GK, CS and SH are full-time employees of Eli Lilly and Company, receive a salary and own company stock. DN and SK were full-time employees of Eli Lilly and Company during the inception of the work.

  • Patient consent for publication Not required.

  • Ethics approval None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.