Comparison of infliximab and ustekinumab for the treatment of moderate-to-severe psoriasis: an indirect comparison meta-analysis

Objectives: As no direct comparisons have been made between infliximab and ustekinumab, the present study's aim was to estimate these drugs' relative efficacy in the treatment of moderate-to-severe psoriasis. Methods: Eleven randomized controlled trials of infliximab 5 mg/kg and ustekinumab 45 mg or 90 mg, reporting Psoriasis Area and Severity Index (PASI) 75 and PASI 90 end points, were identified from a systematic literature review. Of these, five were excluded because they had inappropriate intervention (n = 1), inappropriate patient population (n = 3), or a small sample size (n = 1). Ultimately, six studies were included in the networks. Log odds ratio (OR) of achieving PASI 75 or PASI 90 was used as the treatment effect in fixed- and random-effects mixed treatment comparison meta-analysis. Results: Based on the results of the random-effects model, when compared to infliximab 5 mg/kg, the OR of ustekinumab 90 mg and ustekinumab 45 mg achieving a PASI 75 following 12 weeks of treatment was 0.57 CrI (0.19, 1.29) and 0.44 (0.15, 0.99), respectively. Similarly, the odds of achieving PASI 90 was 0.77 (0.09, 2.70) for ustekinumab 90 mg and 0.63 (0.07, 2.20) for ustekinumab 45 mg. Infliximab 5 mg/kg had the highest probability of being the most effective of all treatments considered, in attaining a PASI 75 (92%) and PASI 90 response (76%). Ustekinumab 90 mg had the highest probability of being ranked second in attaining a PASI 75 (84%) and PASI 90 response (62%). Results from the random- and fixed-effects models were consistent. Conclusion: A greater proportion of patients with plaque psoriasis are expected to achieve a PASI 75 or PASI 90 response when treated with infliximab 5 mg/kg than with ustekinumab 90 mg or 45 mg. Keywords: TNF inhibitor, Interleukin 12/23 inhibitor, biologic therapy, comparative effectiveness, randomized clinical trial, PASI score