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Small-Molecule Inhibitors and Biologics for Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis

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Abstract

Background

The comparative efficacy of biologics and small-molecule inhibitors in treating palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) remains uncertain.

Objective

The aim was to perform a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics and small-molecule inhibitors for the treatment of PP and PPP.

Methods

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for eligible studies from inception to May 13, 2023. This NMA was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Network Meta-Analyses guidelines. Frequentist random-effects models NMA was performed with the surface under the cumulative ranking curve calculated for ranking. Our primary outcome was the proportion of patients achieving a clear/minimal Palmoplantar Psoriasis/Pustulosis Physician Global Assessment score (PPPGA 0/1 or PPPPGA 0/1) response at 12–16 weeks. Secondary outcomes consisted of the percentage of overall improvement in palmoplantar score and of improvement ≥ 75%, at 12–16 weeks.

Results

The study comprised a total of 29 randomized controlled trials (RCTs), involving 4798 psoriasis patients with palmoplantar diseases. For PP, 16 RCTs with nine different treatments, including adalimumab, apremilast, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included for the analysis. In the NMA of PP, secukinumab 300 mg ranked highest (odds ratio [OR] 33.50, 95% confidence interval [CI] 4.37–256.86) in achieving PPPGA 0/1, followed by guselkumab 100 mg (OR 18.68, 95% CI 10.07–34.65). In the case of PPP, seven RCTs with six treatments, including apremilast, etanercept, guselkumab, imsidolimab, spesolimab, and ustekinumab, were included for the analysis. In the NMA of PPP, although no treatment demonstrated a significant difference compared to placebo in achieving PPPPGA 0/1, guselkumab 100 mg showed the greatest statistically significant improvement in the palmoplantar score (weighted mean difference 31.73, 95% CI 19.89–43.57) as a secondary outcome.

Conclusion

Among all available biologics and small-molecule inhibitors, secukinumab 300 mg and guselkumab 100 mg had the most favorable efficacy in treating PP and PPP, respectively.

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Authors and Affiliations

  1. Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

    I-Hsin Huang, Po-Chien Wu & Yu-Huei Huang

  2. Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    I-Hsin Huang & Po-Chien Wu

  3. Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan

    Hsien-Yi Chiu

  4. Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan

    Hsien-Yi Chiu

  5. Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan

    Hsien-Yi Chiu

  6. Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan

    Hsien-Yi Chiu

  7. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yu-Huei Huang

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All authors contributed to the study design. The search strategy development and literature search were performed by IHH and PCW. Data collection and interpretation were conducted by IHH, PCW, HYC, and YHH. Statistical analysis was performed by IHH. The manuscript was drafted by IHH and PCW and critically revised by all other authors. All authors read and approved the final manuscript.

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Huang, IH., Wu, PC., Chiu, HY. et al. Small-Molecule Inhibitors and Biologics for Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis. Am J Clin Dermatol (2024). https://doi.org/10.1007/s40257-024-00849-0

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