Effectiveness and safety of biological and target synthetic drugs treatment for psoriatic arthritis: a systematic review with network meta-analysis

Abstract

Abstract Background:Psoriatic arthritis (PA) is a chronic inflammatory systemic arthritis that can result in loss of functional capacity and joint deformation. This systematic review assessed the effectiveness and safety of biological and target synthetic drugs for treating PA. Methods: We searched for randomized clinical trials (RCTs) that evaluated the use of Adalimumab, Etanercept, Infliximab, Golimumab, Secukinumab, Certolizumab Pegol and Tofacitinib in the main general databases and clinical trial registers databases. The primary outcomes were ACR 50, PsARC, and serious adverse events. Two independent reviewers performed study selection and data extraction. Network meta-analyses were conducted using a random effects model and frequentist approach. The CINeMA software was used to assess the certainty of evidence. Results: We included 33 RCTs (n = 11034). The results from the network meta-analysis for the ACR 50 at 6-months follow-up showed that all drugs were superior to placebo, with Secukinumab, Infliximab and Adalimumab ranking the highest (very low to high certainty of evidence). Regarding the PsARC (at 6-months follow-up), all drugs, except for Golimumab, were superior to placebo, with Etanercept, Infliximab and Certolizumab Pegol being the most effective drugs (very low to moderate certainty of evidence). There were no significant differences in the risk of serious adverse events between the drugs and placebo. Golimumab, Secukinumab, and Adalimumab ranked the highest for safety (very low to low certainty of evidence). Conclusions: In conclusion, based on the balance between efficacy and safety, Secukinumab and Adalimumab appear to be the best options among the evaluated drugs for treating patients with AP. Trial registration: PROSPERO: CRD42022315577