Relative efficacy and safety of tofacitinib for treating psoriasis: A Bayesian network meta-analysis of randomized controlled trials

Abstract

Objective: To assess the relative efficacy and safety of tofacitinib administration (5 and 10 mg) twice daily in psoriasis patients. Materials and methods: Randomized controlled trials (RCTs) examining the efficacy and safety of tofacitinib in psoriasis patients were included in this network meta-analysis. A Bayesian network meta-analysis was performed to combine the direct and indirect evidence from the RCTs. Results: Five RCTs, including 3,265 patients, met the inclusion criteria. The 75% or more reduction in Psoriasis Area and Severity Index (PASI75) response rate was significantly higher in the 10-mg tofacitinib group than in the placebo group (OR, 20.53; 95% credible interval (CrI), 13.98 - 32.69). Similarly, the PASI75 response rate was significantly higher in the 50-mg etanercept and 5-mg tofacitinib groups than in the placebo group (OR, 18.39; 95% CrI, 10.19 - 36.97 and OR, 8.87; 95% CrI, 6.02 - 13.55, respectively). However, 10 mg tofacitinib tended to be more efficacious than 50 mg etanercept and 5 mg tofacitinib. Ranking probability based on Surface under the cumulative ranking curve (SUCRA) indicated that 10 mg tofacitinib had the highest probability of being the best treatment for achieving the PASI75 response rate, followed by 50 mg etanercept, 5 mg tofacitinib, and placebo. The Physician's Global Assessment (PGA) and PASI75 response rates showed similar distribution patterns. In contrast, the number of patients with serious adverse events (SAEs) or withdrawals due to AEs did not differ significantly among the 4 treatment options. Conclusion: Tofacitinib (10 mg) showed the highest efficacy for the intervention for psoriasis, followed by 50 mg etanercept and 5 mg tofacitinib, and was not associated with a significant risk for SAEs or AE-induced withdrawals.