Comparison of short-term adverse reactions of small molecule inhibitors and biologics in the treatment of palmoplantar psoriasis and palmoplantar pustulosis: A systematic review and network Meta-analysis.
Chanxiu Li, Peihan Zhang, Kaige Huang et al.
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In 30 seconds
This systematic review and network meta-analysis compared short-term adverse events with small-molecule inhibitors and biologics in adults with palmoplantar psoriasis (PP) or palmoplantar pustulosis (PPP), using randomized controlled trials. It included 24 studies and 2655 participants. In pooled analyses of PP and PPP, guselkumab 100 mg ranked most favorably for any adverse events (SUCRA 79.22%), while adalimumab 40 mg ranked most favorably for serious adverse events (SUCRA 82.20%) and infections (SUCRA 66.61%). The authors caution that short follow-up, few events, and wide credible intervals limit confidence in these comparisons.
Key findings
- Across PP and PPP, guselkumab 100 mg ranked most favorably for any adverse events (SUCRA: 79.22%).
- In pooled analyses, adalimumab 40 mg ranked most favorably for serious adverse events (SUCRA: 82.20%) and infections (SUCRA: 66.61%).
- In PP, adalimumab 40 mg ranked favorably for any adverse events (SUCRA: 73.93%) and infections (SUCRA: 79.16%); risankizumab 150 mg ranked favorably for serious adverse events (SUCRA: 91.10%).
- In PPP, guselkumab 100 mg ranked favorably for any adverse events (SUCRA: 85.46%) and infections (SUCRA: 81.62%); brodalumab 210 mg ranked favorably for serious adverse events (SUCRA: 68.40%).
Why it matters
Treatment options for PP and PPP are clinically challenging, and adverse-event profiles may inform comparisons among therapies. These rankings offer a synthesis of short-term randomized evidence, including separate results for the two conditions. However, SUCRA rankings do not establish that one treatment is safer in practice, particularly when events are few and estimates are imprecise.
What to keep in mind
Follow-up was short, relevant adverse events were few, and credible intervals were wide; the authors advise interpreting comparative findings with caution.