Efficacy of Janus kinase inhibitors or biologic disease-modifying antirheumatic drugs in psoriatic arthritis patients: a network meta-analysis

Abstract

Introduction: Novel therapeutic agents, which include Janus kinase inhibitors and biologic disease-modifying antirheumatic drugs, are more efficacious than placebo in psoriatic arthritis (PsA) patients. However, there were limited studies to compare efficacy between different novel therapeutic agents. Methods: We searched for randomised controlled trials using ISI Web of Science, Scopus, Medline, Cochrane library, Clinicaltrials.gov, and Embase. Studies reporting the proportion of PsA patients that achieved ACR20 response were included. They were stratified into two groups: (1) biologic-naïve; and (2) intolerant to tumour necrosis factor inhibitor (TNFi). Results were analysed using R version 3.6.1 with “netmeta” version 1.1-0. Odds ratio (OR) and 95% confidence interval (CI) were estimated using random-effects model. P-rank scores were used to estimate the best therapeutic option for a specific group of PsA patients. Results: In this network meta-analysis, 31 studies were included; 29 were in biologic-naïve and nine were in TNFi-intolerant populations. Golimumab was the best option in biologic-naïve patients (P-rank score 0.9324), superior to abatacept (OR [95% CI]=0.14 [0.06-0.36]), adalimumab (0.33 [0.18-0.62]), apremilast (0.21 [0.11-0.38]), certolizumab (0.40 [0.17-0.94]), guselkumab (0.39 [0.20-0.76]), ixekizumab (0.33 [0.16-0.66]), tofacitinib (0.30 [0.14-0.66]), and ustekinumab (0.28 [0.14-0.56]). However, golimumab was not significantly more efficacious than etanercept (0.94 [0.39-2.22]), filgotinib (0.62 [0.21-1.82]), and secukinumab (0.57 [0.30-1.06]). Apremilast was the best option in TNFi-intolerant patients (P-rank score: 0.8479), but there were no significant differences in efficacy between apremilast and other therapeutic agents. Conclusions: All novel therapeutic agents show similar efficacy in PsA patients with TNFi failure. Golimumab is more efficacious than abatacept, adalimumab, apremilast, guselkumab, ixekizumab, tofacitinib, and ustekinumab in biologic-naïve patients.