Biologics have been shown to rapidly reduce the symptoms of moderate-to-severe plaque psoriasis, a chronic dermatologic disease. However, most studies only investigated short-term (<24 weeks) efficacy of the agents, despite the treatments are expected to be used for long-term. Relative benefits of the biologics, especially their long-term efficacy, are unclear. This study aimed to evaluate relative 1-year efficacy of biological agents for patients with plaque psoriasis.

Randomized placebo-controlled clinical trials on the efficacy of biological agents for adult patients with plaque psoriasis treated with biologics in comparison to placebo were searched in the PubMed, EMBASE, and the Cochrane Library databases up to 10 January 2022. The search was conducted with keywords on the names of biological agents in combination with plaque psoriasis or psoriasis vulgaris without language or year limited. Percentages of patients who achieved Psoriasis Area and Severity Index 75%, 90%, and 100% (PASI 75, 90, and 100) improvement of the placebo group at week 10 to week 24 and the biological group at week 48 to week 66 were extracted. The studies were assessed by Cochrane risk of bias tool RoB 2.0. Random effect model was used to assess the pooled odds ratio (OR) of the outcomes.

A total of twenty-one studies (25 trials) including 9852 patients were included in this meta-analysis. The analyzed biologics included TNF-alpha inhibitors infliximab, adalimumab, certolizumab pegol, IL-17 inhibitors secukinumab, ixekizumab, broadalumab, bimekizumab, IL-23 inhibitors guselkumab, tildrakizumab, risakizumab, and an IL-12/23 inhibitor usekinumab. All studies reported PASI 90. Bimekizumab had the highest response (OR 204.43; 95% CI 28.17-1483.63), followed by risankizumab (OR 179.59; 95% CI 79.68-404.78) and secukinumab (OR 177.30; 95% CI 68.61-458.15) in PASI 90. Similar patterns were observed for PASI 75 and PASI 100. Assessment of the results from different types of biologics, IL-17 inhibitors and IL-23 inhibitors showed better treatment effects than TNF-α inhibitors and IL-12/23 inhibitors. 

Overall, IL-17 inhibitors and IL-23 inhibitors had higher levels of one-year long efficacy for patients with plaque psoriasis than TNF-alpha inhibitors and IL-12/23 inhibitors.