International Journal For Multidisciplinary Research

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Comparative Efficacy and Safety of Biologic Therapies for Moderate-to-Severe Psoriasis

Author(s) Dr. Christian Inya Oko, Dr. Collins Gilbert Gilbert, Dr. Ogochukwu Ossai
Country India
Abstract Psoriasis is a chronic, immune-mediated dermatological condition marked by cycles of remission and relapse. Among its subtypes, plaque psoriasis is the most prevalent, accounting for approximately 90% of cases. In patients with moderate-to-severe disease, systemic therapy is often warranted. Biologic therapies, developed over the past two decades, have revolutionized the therapeutic landscape by targeting specific immunological pathways such as TNF-α, IL-12/23, IL-17, and IL-23. While numerous biologics have demonstrated individual efficacy and safety in randomized controlled trials (RCTs), direct comparisons remain limited, creating challenges in clinical decision-making.
To conduct a systematic review of randomized controlled trials to evaluate and compare the clinical efficacy and safety profiles of currently approved biologic therapies for moderate-to-severe plaque psoriasis, thereby guiding evidence-based therapeutic choices.
This systematic review followed PRISMA 2020 guidelines. A thorough search was performed in PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov for RCTs published from January 2010 to March 2025. Inclusion criteria were RCTs involving adults with moderate-to-severe plaque psoriasis treated with FDA- or EMA-approved biologic agents. Data were extracted on PASI 75, PASI 90, and PASI 100 response rates at 12–16 weeks, along with rates of adverse events (AEs), serious adverse events (SAEs), and discontinuation. A total of 28 studies were included in the qualitative synthesis.
IL-17 inhibitors (secukinumab, ixekizumab, brodalumab) and IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab) consistently achieved higher rates of complete or near-complete skin clearance (PASI 90/100) compared to TNF-α inhibitors and ustekinumab. TNF-α inhibitors, while effective, demonstrated comparatively lower response rates and a modestly higher frequency of treatment-related AEs. Ustekinumab maintained a favorable safety profile but lower efficacy relative to newer biologics. Rates of serious adverse events remained low and comparable across most agents.
Newer generation biologics targeting IL-17 and IL-23 pathways demonstrate superior efficacy in achieving rapid and sustained skin clearance in moderate-to-severe psoriasis. Safety profiles were generally favorable, though slight variations in AE profiles necessitate individualized patient assessments. These findings underscore the need for personalized treatment algorithms based on disease severity, comorbidities, and patient preferences.
Keywords Biologic therapies; Moderate-to-severe psoriasis; Plaque psoriasis; PASI 90; IL-17 inhibitors; IL-23 inhibitors; TNF-alpha inhibitors; Comparative efficacy; Safety profile
Field Biology
Published In Volume 7, Issue 4, July-August 2025
Published On 2025-07-08
DOI https://doi.org/10.36948/ijfmr.2025.v07i04.43168
Short DOI https://doi.org/g9s89v
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