Biologic therapies targeting the interleukin (IL)‐23/IL‐17 immune axis for the treatment of moderate‐to‐severe plaque psoriasis: a systematic review and meta‐analysis

Abstract

There are a rapidly increasing number of novel biologic therapies for psoriasis targeting interleukin‐23 (IL‐23) and interleukin‐17 (IL‐17). This systematic review and meta‐analysis evaluated the efficacy and safety of induction therapy (12–16 weeks) with biologic therapies targeting the IL‐23/IL‐17 immune axis for the treatment of moderate‐to‐severe plaque psoriasis. Twenty‐seven randomized controlled trials met the specified inclusion criteria. The results showed that ixekizumab q2w had the greatest efficacy in terms of achieving 90% reduction in Psoriasis Area and Severity Index when compared to placebo [risk ratio (RR): 65.01, 95% confidence intervals (CI): 13.97–302.56, P < 0.00001], etanercept (RR: 3.14, 95% CI: 2.22–4.45) and ustekinumab (RR: 1.73, 95% CI: 1.41–2.12). The IL‐17 inhibitors were overall shown to have a higher efficacy than the IL‐23 inhibitors during induction therapy. However, the IL‐17 inhibitors had an increased risk of adverse events when compared to placebo, while there was no increased risk with any of the IL‐23 inhibitors. In conclusion, induction therapy with IL‐17 inhibitors is highly efficacious but carries a higher risk of adverse events than induction therapy with IL‐23 inhibitors.