Treatment of plaque psoriasis with IL-23p19 blockers: A systematic review and meta-analysis

Interleukin(IL)-23 is a key cytokine in the pathogenesis of psoriasis, this meta-analysis was to analyze the efficacy and safety of IL-23p19 blockers in patients with plaque psoriasis.

A systematic review of the literature was performed to collect double-blind randomized controlled trials(RCTs). The pooled relative risk(RR) with 95% confidence interval(CI) was calculated. All analyses were conducted with intention-to-treat basis.

A total of 13 studies contained 5155 plaque psoriasis patients were included in our meta-analysis. The results indicated that IL-23p19 blockers had better efficacy than placebo for Psoriasis Area Severity Index score reductions from baseline of 75% or more (PASI75) (RR = 11.47, P < 0.001) and static Physician's Global Assessment score of 0 or 1(sPGA0/1) (RR = 11.32, P < 0.001). IL-23p19 blockers have similar safety with placebo about the incidence of adverse events(AEs) (RR = 1.22, P = 0.096) and serious adverse events(SAEs) (RR = 2.93, P = 0.965), but IL-23p19 blockers carried an increased incidence rate of infections (RR = 1.39, P < 0.001). While compared with adalimumab and ustekinumab, IL-23p19 blockers were more effective and had the similar tolerance. Among three IL-23p19 blockers, guselkumab was the most efficacious treatments, and risankizumab was better tolerated than the others.

The IL-23p19 blockers have excellent efficacy and great safety in plaque psoriasis patients, but long-term safety remains to be determined.