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Network Meta-Analysis To Evaluate The Efficacy of Ixekizumab In The Treatment of Moderate-To-Severe Psoriasis

      Objectives

      Evidence generated by network meta-analysis (NMA) is increasingly being accepted by health-care decision makers to assess the added benefits of a new intervention versus alternative treatment option(s), based on all available evidence. This research reports the results of a NMA conducted to evaluate the relative efficacy of ixekizumab in the treatment of patients with moderate-to-severe psoriasis (Pso).

      Methods

      Data to populate the NMA were identified through a systematic literature review of the published and grey literature (1990 to Nov 2015). Relevant treatments included in the base case NMA were adalimumab, etanercept, infliximab, secukinumab and ustekinumab at their NICE approved doses. The Psoriasis Area and Severity Index (PASI) response was used primarily as the measure of efficacy. A Bayesian random-effects model using multinomial likelihood and probit-link, published by the NICE Decision Support Unit, was utilised for this NMA. Diagnostic tests were used to examine heterogeneity and inconsistency in the network; robustness of the results was investigated in multiple sensitivity analyses.

      Results

      A total of 31 randomised, controlled trials were included in the base case NMA. Patient characteristics were similar across studies, with the exception of race. Significant treatment effects with respect to PASI response were obtained in favour of ixekizumab 160 mg followed by ixekizumab 80mg every other week (Q2W), versus each of the other biologic agents. The probability of ixekizumab 80mg Q2W being ranked the best therapy was 96.3%, with secukinumab and infliximab being ranked the next best alternative therapies. The conditional probabilities of attaining a PASI ≥ 75% response for ixekizumab 80mg Q2W, secukinumab and infliximab were 89.5%, 81.8%, and 81.4%, respectively. No significant heterogeneity or inconsistencies were identified and the results were consistent across all the sensitivity analyses undertaken.

      Conclusions

      This NMA suggests ixekizumab 80mg Q2W is the most effective approved treatment option for patients with moderate-to-severe Pso.