Efficacy of biologic agents for palmoplantar psoriasis: a systematic review and network meta-analysis

ABSTRACTBackground Palmoplantar psoriasis (PP) represents a localized type of disease. While controversy over its’ classification exists, a hyperkeratotic type, a pustular type and palmoplantar pustulosis (PPP) have been recognized. PP management is regularly supported by biologic agents. Our study aimed to review and synthesize available data regarding the efficacy of approved biologics for PP and PPP.Research design and methods A literature search was conducted in PubMed, CENTRAL, Scopus, and ClinicalTrilas.gov. Utilizing random-effects inverse-variance frequentist network meta-analyses (NMAs), we ranked interventions. The proportion of participants with cleared skin was the primary outcome. Fifty and 75% improvement in palmoplantar psoriasis area severity index (PPASI) were also explored (PPASI50, PPASI75).Results In total, 15 randomized controlled trials (RCTs) exploring the efficacy of on-label adalimumab, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included. Data for PP were synthesized. Every biologic agent examined, except from infliximab, outperformed placebo. On-label secukinumab exhibited the highest probability of inducing complete resolution. Ixekizumab and infliximab ranked best on inducing PPASI50 and PPASI75. Our review supports that guselkumab is effective for PPP.Conclusions Secukinumab, ixekizumab and infliximab are effective for PP. Research is warranted to produce evidence about the efficacy of biologics in PP and PPP.KEYWORDS: Network meta-analysisanti-IL-17anti-IL-23anti-TNFpalmssoles Declaration of interestsD Bogdanos: lecture honoraria (2020–2022): Menarini Hellas, Boehringer Ingelheim, Genesis Pharma, Fresenius Kabi, congress travel and accommodation support from Hospital Iine, Pfizer, Elpen, Aenorasis Hellas. E Zafiriou: consulting fees: Abbvie, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, payment or honoraria: Abbvie, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, support for attending meetings: Abbvie, Genesis Pharma, Novartis, Jannsen, Pharmaserv Lilly, Sanofi, UCB. A Patsatsi: consulting fees: Abbvie, Argenx, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, payment or honoraria: Abbvie, Argenx, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Pfizer, Sanofi, UCB, support for attending meetings: Abbvie, Argenx, Genesis Pharma, Leo, Novartis, Jannsen, Pharmaserv Lilly, Sanofi, UCB. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsConceptualization, A Patsatsi and S Tsiogkas; methodology, M Grammatikopoulou, KM Kontouli, S Tsiogkas and I Minopoulou; formal analysis, M Grammatikopoulou, KM Kontouli and S Tsiogkas; investigation, S Tsiogkas, I Minopoulou and M Grammatikopoulou; data curation,, S Tsiogkas, I Minopoulou and M Grammatikopoulou; writing – original draft preparation, S Tsiogkas, M Grammatikopoulou and D Bogdanos; writing – review and editing, S Tsiogkas, M Grammatikopoulou, I Minopoulou, KM Kontouli, D Goulis, D Bogdanos, E Zafiriou, A Patsatsi; visualization, M Grammatikopoulou and S Tsiogkas; supervision, D Bogdanos and A Patsatsi; project administration, D Bogdanos.Data availability statementData sharing does not apply to this study as new data were neither created nor analyzed for this systematic review. Data extraction form is available upon request.AcknowledgmentsWe would like to thank E Rigopoulou for her critical comments.Supplementary materialSupplemental data for this article can be accessed online at https://doi.org/10.1080/1744666X.2023.2272049Additional informationFundingThis paper was not funded.