Efficacy of Biological or Targeted Synthetic Disease-Modifying Anti-Rheumatic Drugs in Active Psoriatic Arthritis: A Network Meta-Analysis of Randomized Controlled Trials

Objective: Many biological or targeted synthetic disease-modifying anti-rheumatic drugs (b/ts DMARDs) are used in the treatment of psoriatic arthritis (PsA) during recent years, but there are few head-to-head studies that directly compare these drugs to evaluate and compare the relative efficacy of these treatments at week 24. The aim of this study is to conduct a comprehensive comparison of all clinically used bDMARDs or tsDMARDs for PSA using a network meta-analysis to evaluate relative efficacy of these drugs, which is evaluated by ACR20, ACR50, ACR70, PASI75, and PASI90. Methods: All randomized controlled trials of these treatments are searched in PubMed, Web of Science, and Embase, and data are extracted from the included articles, and network meta-analysis is performed using the Stata 13 software. Results: secukinumab 300 mg is the top-ranked treatment for ACR20 and PASI90, infliximab 5 mg/kg is the top-ranked treatment for ACR50, and adalimumab 40 mg is the top-ranked treatment for ACR70 and PASI75. Conclusions: Tumor necrosis factor-alpha inhibitors and interleukin 17A inhibitors are the top-ranked treatments for arthritis and skin responses of active PsA.