Efficacy of biologic agents for palmoplantar psoriasis: a systematic review and network meta-analysis

Palmoplantar psoriasis (PP) represents a localized type of disease. While controversy over its’ classification exists, a hyperkeratotic type, a pustular type and palmoplantar pustulosis (PPP) have been recognized. PP management is regularly supported by biologic agents. Our study aimed to review and synthesize available data regarding the efficacy of approved biologics for PP and PPP. A literature search was conducted in PubMed, CENTRAL, Scopus, and ClinicalTrilas.gov. Utilizing random-effects inverse-variance frequentist network meta-analyses (NMAs), we ranked interventions. The proportion of participants with cleared skin was the primary outcome. Fifty and 75% improvement in palmoplantar psoriasis area severity index (PPASI) were also explored (PPASI50, PPASI75). In total, 15 randomized controlled trials (RCTs) exploring the efficacy of on-label adalimumab, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included. Data for PP were synthesized. Every biologic agent examined, except from infliximab, outperformed placebo. On-label secukinumab exhibited the highest probability of inducing complete resolution. Ixekizumab and infliximab ranked best on inducing PPASI50 and PPASI75. Our review supports that guselkumab is effective for PPP. Secukinumab, ixekizumab and infliximab are effective for PP. Research is warranted to produce evidence about the efficacy of biologics in PP and PPP.

掌跖银屑病（Palmoplantar psoriasis, PP）是一类局限性皮肤病。尽管其分类尚存争议，但目前已公认存在角化过度型、脓疱型以及掌跖脓疱病（Palmoplantar pustulosis, PPP）三种分型。PP的临床治疗常以生物制剂作为主要支持手段。本研究旨在综述并整合现有关于获批生物制剂治疗PP与PPP的疗效数据。研究通过PubMed、CENTRAL、Scopus及ClinicalTrials.gov开展文献检索，采用随机效应逆方差频次网络meta分析（Network Meta-Analyses, NMAs）对干预措施进行疗效排序。本研究的主要结局指标为皮损完全清除的受试者占比，同时也探究了掌跖银屑病面积与严重程度指数（Palmoplantar Psoriasis Area and Severity Index, PPASI）达到50%、75%改善的情况（即PPASI50、PPASI75）。本研究共纳入15项随机对照试验（Randomized Controlled Trials, RCTs），评估了标签内适应证使用的阿达木单抗、比美吉珠单抗、依那西普、古塞库单抗、英夫利昔单抗、依奇珠单抗、司库奇尤单抗及乌司奴单抗的疗效，并对PP相关数据进行了整合分析。结果显示，除英夫利昔单抗外，所有受试生物制剂的疗效均显著优于安慰剂；标签内使用的司库奇尤单抗实现皮损完全清除的概率最高；依奇珠单抗与英夫利昔单抗在实现PPASI50、PPASI75改善方面表现最优。本综述证实古塞库单抗对PPP具有治疗有效性，司库奇尤单抗、依奇珠单抗及英夫利昔单抗对PP亦具备治疗价值。未来仍需开展相关研究以获取生物制剂治疗PP与PPP的更多循证证据。