Biologic and Non-Biologic Therapies for Scalp Psoriasis: A Network Meta-analysis of Randomized Controlled Trials

Abstract

Introduction: Scalp psoriasis affects up to 80% of patients with plaque-type psoriasis and is often resistant to topical and conventional systemic agents. There is a lack of consensus on a “gold standard” treatment. Objective: This comprehensive review and network meta-analysis aimed to compare the efficacy and safety of studied interventions. Methods: The Ovid MEDLINE(R), Embase, and Cochrane databases were searched from 01 January 2000 to 05 October 2022. All English-language randomized controlled trials evaluating an intervention for scalp psoriasis were included if they reported one of the following clinical outcomes: Psoriasis Scalp Severity Index (PSSI), scalp Physician Global Assessment (ScPGA), scalp-specific Investigator or Physician Global Assessment (IGA/PGA), and Total Sign Score (TSS), and adverse events. A random effects network meta-analysis was performed where possible, and network plots were generated. Results: Of 1,046 studies identified, 35 met the inclusion criteria, with seven in the PSSI analysis and 16 in the IGA analysis. All interventions led to an improvement in all outcomes when compared to placebo in the PSSI and PGA/IGA. For the PSSI response, secukinumab 300 mg every four weeks (Q4W) was the most effective (SUCRA 0.991). For the PGA/IGA response, bimekizumab 320 mg Q4W was the most effective (SUCRA 0.975). Conclusions: Several systemic therapies are superior to placebo in improving clinical outcomes, with secukinumab 300 mg Q4W and bimekizumab 320 mg Q4W deemed the most effective among biologic agents analyzed. Efforts to enhance research standardization, including head-to-head trials with standardized outcome measures, diverse patient recruitment, and long-term follow-up, are crucial next steps in assessing treatment efficacy and adverse events.