6ER-026 A network meta-analysis of biological and targeted synthetic drugs in refractory psoriatic arthritis

<h3>Background and Importance</h3> At present, a considerable number of drugs are available for the treatment of refractory psoriatic arthritis (PsA). However, the lack of direct comparative studies of the available alternatives results in considerable uncertainty regarding their respective therapeutic positions. <h3>Aim and Objectives</h3> To develop a network meta-analysis (NMA) to provide a comparison of the efficacy of treatments in PsA. <h3>Material and Methods</h3> A systematic review was conducted on 1 March 2024 in PubMed and Embase. Inclusion criteria: phase II/III randomised controlled trials (RCTs) that included biological disease-modifying antirheumatic drugs (bDMARDs) (etanercept, infliximab, adalimumab, certolizumab pegol, golimumab, secukinumab, ixekizumab, brodalumab, remtolumab, bimekizumab, guselkumab, risankizumab, and tildrakizumab) and targeted synthetic (tsDMARD) (tofacitinib, upadacitinib, and deucravacitinib) as treatments for patients with PsA, reporting outcomes for the American College of Rheumatology 50% improvement criteria (ACR50). Exclusion criteria: patients under 18 years-old. Efficacy outcome: ACR50 at week 12 or the forthcoming time point. The NMA combined direct and indirect evidence in order to calculate pooled odds ratios (ORs) using Bayesian methodology. The GEMTC and BUGSNET packages for R-Statistics and the MetaInsight application were utilised for this analysis. <h3>Results</h3> A total of 53 RCTs with 22,365 patients and 51 different intervention arms were included. An NMA using Bayesian random effects models was performed for the ACR50 outcome against placebo. Ixekizumab 80mg every 2 weeks (IXE80 Q2W) demonstrated the most favourable outcome in comparison to the comparator and was therefore used as the reference treatment. The NMA comparing all treatments to IXE80 Q2W demonstrated no treatment superiority, and the majority of comparisons did not reveal statistically significant differences. Nevertheless, IXE80 exhibited statistically significant superiority (p&lt;0.05) in comparison to the following treatments: abatacept, apremilast 20 mg and 30 mg, etanercept 50 mg, guselkumab, risankizumab, secukinumab 75 mg, tildrakizumab 20 mg and 100 mg, tofacitinib 5 mg, and ustekinumab 45 mg Q12W. A sensitivity analysis employing frequentist methods corroborated the consistency of these results. <h3>Conclusion and Relevance</h3> Ixekizumab 80 mg Q2W has been demonstrated to be an efficacious standard treatment, with no other treatment demonstrating superior efficacy. Furthermore, the safety criteria must be considered into account when determining the optimal therapeutic positioning of drugs in this clinical context. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest