Long-term efficacy of biologic therapies for moderate-to-severe plaque psoriasis: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 MIAO Yanan ^1,2 , TAO Ying ^1,2 , LI Ying ³ , LIU Yanru ³ ,  WANG Wei ^1,2

1. School of Public Health, Fudan University, Shanghai 200032, P. R. China;
2. NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai 200032, P. R. China;
3. Shanghai Skin Disease Hospital, Shanghai 200443, P. R. China;

Corresponding author：

WANG Wei, Email: wangw_vivian@fudan.edu.cn

Keywords：

Moderate-to-severe plaque psoriasis; Biologics; Efficacy; Long-term; Network meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202201103

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the long-term efficacy of biologics for moderate to severe plaque psoriasis. Methods PubMed, EMbase, Web of Science and The Cochrane Library were electronically searched to collect randomized controlled trials (RCTs) on the long-term efficacy of approved biologics for moderate to severe plaque psoriasis from inception to May 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies; then, the network meta-analysis was performed by using Stata 16.0 software. Results A total of 26 RCTs were included. The results of network meta-analysis showed that among 11 biologics, the most effective biologics were risankizumab, followed by bimekizumab, brodalumab, guselkumab, and ixekizumab, and followed by secukinumab, adalimumab, ustekinumab, and etanercept was the last. Conclusion Current evidence shows that risankizumab is likely to be the best option for long-term treatment of moderate-to-severe plaque psoriasis. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： MIAO Yanan, TAO Ying, LI Ying, LIU Yanru, WANG Wei. Long-term efficacy of biologic therapies for moderate-to-severe plaque psoriasis: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(8): 917-925. doi: 10.7507/1672-2531.202201103 Copy

1.	Girolomoni G, Strohal R, Puig L, et al. The role of IL-23 and the IL-23/TH17 immune axis in the pathogenesis and treatment of psoriasis. J Eur Acad Dermatol Venereol, 2017, 31(10): 1616-1626.
2.	中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南(2018简版). 中华皮肤科杂志, 2019, 52(4): 223-230.
3.	Mrowietz U, Kragballe K, Reich K, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res, 2011, 303(1): 1-10.
4.	Bai F, Li GG, Liu Q, et al. Short-term efficacy and safety of IL-17, IL-12/23, and IL-23 inhibitors brodalumab, secukinumab, ixekizumab, ustekinumab, guselkumab, tildrakizumab, and risankizumab for the treatment of moderate to severe plaque psoriasis: a systematic review and network meta-analysis of randomized controlled trials. J Immunol Res, 2019, 2019: 2546161.
5.	Lv J, Zhou D, Wang Y, et al. Quantitative evaluation to efficacy and safety of therapies for psoriasis: a network meta-analysis. Mol Pain, 2018, 14: 1744806918762205.
6.	Mahil SK, Ezejimofor MC, Exton LS, et al. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis. Br J Dermatol, 2020, 183(4): 638-649.
7.	Sawyer LM, Malottki K, Sabry-Grant C, et al. Assessing the relative efficacy of interleukin-17 and interleukin-23 targeted treatments for moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis of PASI response. PLoS One, 2019, 14(8): e0220868.
8.	Sbidian E, Chaimani A, Afach S, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev, 2020, (1): CD011535.
9.	Tada Y, Watanabe R, Noma H, et al. Short-term effectiveness of biologics in patients with moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis. J Dermatol Sci, 2020, 99(1): 53-61.
10.	Xu G, Xia M, Jiang C, et al. Comparative efficacy and safety of thirteen biologic therapies for patients with moderate or severe psoriasis: A network meta-analysis. J Pharmacol Sci, 2019, 139(4): 289-303.
11.	Xu S, Gao X, Deng J, et al. Comparative efficacy and safety of biologics in moderate to severe plaque psoriasis: a multiple-treatments meta-analysis. J Dtsch Dermatol Ges, 2021, 19(1): 47-56.
12.	Armstrong AW, Soliman AM, Betts KA, et al. Comparative efficacy and relative ranking of biologics and oral therapies for moderate-to-severe plaque psoriasis: a network meta-analysis. Dermatol Ther (Heidelb), 2021, 11(3): 885-905.
13.	Yasmeen N, Sawyer LM, Malottki K, et al. Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year. J Dermatolog Treat, 2022, 33(1): 204-218.
14.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Available at: http://handbook.cochrane.org.
15.	Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ, 2011, 342: d549.
16.	Higgins JP, Jackson D, Barrett JK, et al. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods, 2012, 3(2): 98-110.
17.	Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8): 932-944.
18.	Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
19.	栗梦婷, 朱鸿飞, 后亮瑛, 等. 网状Meta分析结论形成的方法: 最小背景化框架. 中国循证医学杂志, 2021, 21(9): 1102-1109.
20.	王琪, 王建成, 潘蓓, 等. 网状Meta分析证据质量分级: GRADE方法学前沿与进展. 中国循证医学杂志, 2020, 20(8): 979-985.
21.	Tyring S, Gordon KB, Poulin Y, et al. Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol, 2007, 143(6): 719-726.
22.	Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol, 2007, 56(1): 31.e1-15.
23.	Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase 3, multicentre, double-blind trial. Lancet, 2005, 366(9494): 1367-1374.
24.	Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis-results of two phase 3 trials. N Engl J Med, 2014, 371(4): 326-338.
25.	Cai L, Zhang JZ, Yao X, et al. Secukinumab demonstrates high efficacy and a favorable safety profile over 52 weeks in Chinese patients with moderate to severe plaque psoriasis. Chin Med J (Engl), 2020, 133(22): 2665-2673.
26.	Ohtsuki M, Kubo H, Morishima H, et al. Guselkumab, an anti-interleukin-23 monoclonal antibody, for the treatment of moderate to severe plaque-type psoriasis in Japanese patients: efficacy and safety results from a phase 3, randomized, double-blind, placebo-controlled study. J Dermatol, 2018, 45(9): 1053-1062.
27.	Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet, 2008, 371(9625): 1665-1674.
28.	Igarashi A, Kato T, Kato M, et al. Efficacy and safety of ustekinumab in Japanese patients with moderate-to-severe plaque-type psoriasis: long-term results from a phase 2/3 clinical trial. J Dermatol, 2012, 39(3): 242-252.
29.	Gottlieb AB, Blauvelt A, Thaçi D, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol, 2018, 79(2): 302-314.
30.	Ohtsuki M, Fujita H, Watanabe M, et al. Efficacy and safety of risankizumab in Japanese patients with moderate to severe plaque psoriasis: results from the SustaIMM phase 2/3 trial. J Dermatol, 2019, 46(8): 686-694.
31.	Blauvelt A, Prinz JC, Gottlieb AB, et al. Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol, 2015, 172(2): 484-493.
32.	Lacour JP, Paul C, Jazayeri S, et al. Secukinumab administration by autoinjector maintains reduction of plaque psoriasis severity over 52 weeks: results of the randomized controlled JUNCTURE trial. J Eur Acad Dermatol Venereol, 2017, 31(5): 847-856.
33.	Paul C, Griffiths CEM, van de Kerkhof PCM, et al. Ixekizumab provides superior efficacy compared with ustekinumab over 52 weeks of treatment: Results from IXORA-S, a phase 3 study. J Am Acad Dermatol, 2019, 80(1): 70-79.
34.	Bagel J, Blauvelt A, Nia J, et al. Secukinumab maintains superiority over ustekinumab in clearing skin and improving quality of life in patients with moderate to severe plaque psoriasis: 52-week results from a double-blind phase 3b trial (CLARITY). J Eur Acad Dermatol Venereol, 2021, 35(1): 135-142.
35.	Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study. J Am Acad Dermatol, 2017, 76(1): 60-69.
36.	Warren RB, Blauvelt A, Poulin Y, et al. Efficacy and safety of risankizumab vs. secukinumab in patients with moderate-to-severe plaque psoriasis (IMMerge):results from a phase Ⅲ, randomized, open-label, efficacy-assessor-blinded clinical trial. Br J Dermatol, 2021, 184(1): 50-59.
37.	Reich K, Armstrong AW, Langley RG, et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial. Lancet, 2019, 394(10201): 831-839.
38.	Gordon KB, Blauvelt A, Papp KA, et al. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med, 2016, 375(4): 345-356.
39.	Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase Ⅲ, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol, 2017, 76(3): 405-417.
40.	Reich K, Papp KA, Blauvelt A, et al. Bimekizumab versus ustekinumab for the treatment of moderate to severe plaque psoriasis (BE VIVID): efficacy and safety from a 52-week, multicentre, double-blind, active comparator and placebo controlled phase 3 trial. Lancet, 2021, 397(10273): 487-498.
41.	Lebwohl M, Strober B, Menter A, et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med, 2015, 373(14): 1318-1328.
42.	Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet, 2018, 392(10148): 650-661.
43.	Warren RB, See K, Burge R, et al. Rapid response of biologic treatments of moderate-to-severe plaque psoriasis: a comprehensive investigation using bayesian and frequentist network meta-analyses. Dermatol Ther (Heidelb), 2020, 10(1): 73-86.
44.	中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会, 中国中西医结合学会皮肤性病专业委员会. 中国银屑病生物制剂治疗指南(2021). 中华皮肤科杂志, 2021, 54(12): 1033-1047.
45.	Asahina A, Nakagawa H, Etoh T, et al. Adalimumab in Japanese patients with moderate to severe chronic plaque psoriasis: efficacy and safety results from a Phase Ⅱ/Ⅲ randomized controlled study. J Dermatol, 2010, 37(4): 299-310.

1. Girolomoni G, Strohal R, Puig L, et al. The role of IL-23 and the IL-23/TH17 immune axis in the pathogenesis and treatment of psoriasis. J Eur Acad Dermatol Venereol, 2017, 31(10): 1616-1626.
2. 中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南(2018简版). 中华皮肤科杂志, 2019, 52(4): 223-230.
3. Mrowietz U, Kragballe K, Reich K, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res, 2011, 303(1): 1-10.
4. Bai F, Li GG, Liu Q, et al. Short-term efficacy and safety of IL-17, IL-12/23, and IL-23 inhibitors brodalumab, secukinumab, ixekizumab, ustekinumab, guselkumab, tildrakizumab, and risankizumab for the treatment of moderate to severe plaque psoriasis: a systematic review and network meta-analysis of randomized controlled trials. J Immunol Res, 2019, 2019: 2546161.
5. Lv J, Zhou D, Wang Y, et al. Quantitative evaluation to efficacy and safety of therapies for psoriasis: a network meta-analysis. Mol Pain, 2018, 14: 1744806918762205.
6. Mahil SK, Ezejimofor MC, Exton LS, et al. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis. Br J Dermatol, 2020, 183(4): 638-649.
7. Sawyer LM, Malottki K, Sabry-Grant C, et al. Assessing the relative efficacy of interleukin-17 and interleukin-23 targeted treatments for moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis of PASI response. PLoS One, 2019, 14(8): e0220868.
8. Sbidian E, Chaimani A, Afach S, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev, 2020, (1): CD011535.
9. Tada Y, Watanabe R, Noma H, et al. Short-term effectiveness of biologics in patients with moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis. J Dermatol Sci, 2020, 99(1): 53-61.
10. Xu G, Xia M, Jiang C, et al. Comparative efficacy and safety of thirteen biologic therapies for patients with moderate or severe psoriasis: A network meta-analysis. J Pharmacol Sci, 2019, 139(4): 289-303.
11. Xu S, Gao X, Deng J, et al. Comparative efficacy and safety of biologics in moderate to severe plaque psoriasis: a multiple-treatments meta-analysis. J Dtsch Dermatol Ges, 2021, 19(1): 47-56.
12. Armstrong AW, Soliman AM, Betts KA, et al. Comparative efficacy and relative ranking of biologics and oral therapies for moderate-to-severe plaque psoriasis: a network meta-analysis. Dermatol Ther (Heidelb), 2021, 11(3): 885-905.
13. Yasmeen N, Sawyer LM, Malottki K, et al. Targeted therapies for patients with moderate-to-severe psoriasis: a systematic review and network meta-analysis of PASI response at 1 year. J Dermatolog Treat, 2022, 33(1): 204-218.
14. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Available at: http://handbook.cochrane.org.
15. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ, 2011, 342: d549.
16. Higgins JP, Jackson D, Barrett JK, et al. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods, 2012, 3(2): 98-110.
17. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med, 2010, 29(7-8): 932-944.
18. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
19. 栗梦婷, 朱鸿飞, 后亮瑛, 等. 网状Meta分析结论形成的方法: 最小背景化框架. 中国循证医学杂志, 2021, 21(9): 1102-1109.
20. 王琪, 王建成, 潘蓓, 等. 网状Meta分析证据质量分级: GRADE方法学前沿与进展. 中国循证医学杂志, 2020, 20(8): 979-985.
21. Tyring S, Gordon KB, Poulin Y, et al. Long-term safety and efficacy of 50 mg of etanercept twice weekly in patients with psoriasis. Arch Dermatol, 2007, 143(6): 719-726.
22. Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol, 2007, 56(1): 31.e1-15.
23. Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase 3, multicentre, double-blind trial. Lancet, 2005, 366(9494): 1367-1374.
24. Langley RG, Elewski BE, Lebwohl M, et al. Secukinumab in plaque psoriasis-results of two phase 3 trials. N Engl J Med, 2014, 371(4): 326-338.
25. Cai L, Zhang JZ, Yao X, et al. Secukinumab demonstrates high efficacy and a favorable safety profile over 52 weeks in Chinese patients with moderate to severe plaque psoriasis. Chin Med J (Engl), 2020, 133(22): 2665-2673.
26. Ohtsuki M, Kubo H, Morishima H, et al. Guselkumab, an anti-interleukin-23 monoclonal antibody, for the treatment of moderate to severe plaque-type psoriasis in Japanese patients: efficacy and safety results from a phase 3, randomized, double-blind, placebo-controlled study. J Dermatol, 2018, 45(9): 1053-1062.
27. Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet, 2008, 371(9625): 1665-1674.
28. Igarashi A, Kato T, Kato M, et al. Efficacy and safety of ustekinumab in Japanese patients with moderate-to-severe plaque-type psoriasis: long-term results from a phase 2/3 clinical trial. J Dermatol, 2012, 39(3): 242-252.
29. Gottlieb AB, Blauvelt A, Thaçi D, et al. Certolizumab pegol for the treatment of chronic plaque psoriasis: results through 48 weeks from 2 phase 3, multicenter, randomized, double-blinded, placebo-controlled studies (CIMPASI-1 and CIMPASI-2). J Am Acad Dermatol, 2018, 79(2): 302-314.
30. Ohtsuki M, Fujita H, Watanabe M, et al. Efficacy and safety of risankizumab in Japanese patients with moderate to severe plaque psoriasis: results from the SustaIMM phase 2/3 trial. J Dermatol, 2019, 46(8): 686-694.
31. Blauvelt A, Prinz JC, Gottlieb AB, et al. Secukinumab administration by pre-filled syringe: efficacy, safety and usability results from a randomized controlled trial in psoriasis (FEATURE). Br J Dermatol, 2015, 172(2): 484-493.
32. Lacour JP, Paul C, Jazayeri S, et al. Secukinumab administration by autoinjector maintains reduction of plaque psoriasis severity over 52 weeks: results of the randomized controlled JUNCTURE trial. J Eur Acad Dermatol Venereol, 2017, 31(5): 847-856.
33. Paul C, Griffiths CEM, van de Kerkhof PCM, et al. Ixekizumab provides superior efficacy compared with ustekinumab over 52 weeks of treatment: Results from IXORA-S, a phase 3 study. J Am Acad Dermatol, 2019, 80(1): 70-79.
34. Bagel J, Blauvelt A, Nia J, et al. Secukinumab maintains superiority over ustekinumab in clearing skin and improving quality of life in patients with moderate to severe plaque psoriasis: 52-week results from a double-blind phase 3b trial (CLARITY). J Eur Acad Dermatol Venereol, 2021, 35(1): 135-142.
35. Blauvelt A, Reich K, Tsai TF, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis up to 1 year: Results from the CLEAR study. J Am Acad Dermatol, 2017, 76(1): 60-69.
36. Warren RB, Blauvelt A, Poulin Y, et al. Efficacy and safety of risankizumab vs. secukinumab in patients with moderate-to-severe plaque psoriasis (IMMerge):results from a phase Ⅲ, randomized, open-label, efficacy-assessor-blinded clinical trial. Br J Dermatol, 2021, 184(1): 50-59.
37. Reich K, Armstrong AW, Langley RG, et al. Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial. Lancet, 2019, 394(10201): 831-839.
38. Gordon KB, Blauvelt A, Papp KA, et al. Phase 3 trials of ixekizumab in moderate-to-severe plaque psoriasis. N Engl J Med, 2016, 375(4): 345-356.
39. Blauvelt A, Papp KA, Griffiths CE, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase Ⅲ, double-blinded, placebo- and active comparator-controlled VOYAGE 1 trial. J Am Acad Dermatol, 2017, 76(3): 405-417.
40. Reich K, Papp KA, Blauvelt A, et al. Bimekizumab versus ustekinumab for the treatment of moderate to severe plaque psoriasis (BE VIVID): efficacy and safety from a 52-week, multicentre, double-blind, active comparator and placebo controlled phase 3 trial. Lancet, 2021, 397(10273): 487-498.
41. Lebwohl M, Strober B, Menter A, et al. Phase 3 studies comparing brodalumab with ustekinumab in psoriasis. N Engl J Med, 2015, 373(14): 1318-1328.
42. Gordon KB, Strober B, Lebwohl M, et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet, 2018, 392(10148): 650-661.
43. Warren RB, See K, Burge R, et al. Rapid response of biologic treatments of moderate-to-severe plaque psoriasis: a comprehensive investigation using bayesian and frequentist network meta-analyses. Dermatol Ther (Heidelb), 2020, 10(1): 73-86.
44. 中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会, 中国中西医结合学会皮肤性病专业委员会. 中国银屑病生物制剂治疗指南(2021). 中华皮肤科杂志, 2021, 54(12): 1033-1047.
45. Asahina A, Nakagawa H, Etoh T, et al. Adalimumab in Japanese patients with moderate to severe chronic plaque psoriasis: efficacy and safety results from a Phase Ⅱ/Ⅲ randomized controlled study. J Dermatol, 2010, 37(4): 299-310.

Chinese Journal of Evidence-Based Medicine

Long-term efficacy of biologic therapies for moderate-to-severe plaque psoriasis: a network meta-analysis

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