Are biologic drugs better than placebo for treating plaque psoriasis in children?
Biologic drugs are a type of medication that targets specific parts of the immune system to reduce inflammation. For children with moderate to severe plaque psoriasis, several biologics have been approved by the FDA, including secukinumab (Cosentyx) and ustekinumab (Stelara) for patients aged 6 years and older 12. Clinical trials consistently show that these drugs work much better than placebo (an inactive treatment) at clearing psoriasis and improving quality of life in children.
What the research says
A network meta-analysis of 7 randomized controlled trials involving 1,016 children with plaque psoriasis found that all biologic therapies were significantly better than placebo at achieving at least a 90% improvement in psoriasis severity (PASI90) and at least a 75% improvement (PASI75) 48. For example, secukinumab (Cosentyx) at high doses ranked best for PASI90, while ixekizumab ranked highest for complete skin clearance (PASI100) 48. Another systematic review of 84 trials in adults and children also confirmed that biologics like infliximab, ixekizumab, and brodalumab are far more effective than placebo 6. In a phase 3 trial specifically in children aged 6 to <18 years, both low and high doses of secukinumab were significantly better than placebo at week 12, and the improvement lasted over the long term 7. Similarly, ustekinumab (Stelara) is approved for children 6 years and older based on trial data showing superiority over placebo 23. Overall, the evidence is strong that biologics outperform placebo in pediatric plaque psoriasis.
What to ask your doctor
- Which biologic drugs are approved for my child's age and psoriasis severity?
- What are the possible side effects of biologics in children, and how are they monitored?
- How long does it typically take to see improvement after starting a biologic?
- Are there any special considerations for vaccines or infections while my child is on a biologic?
- How do the costs and insurance coverage compare for different biologic options?
This question is drawn from common patient questions about Pediatrics and answered using cited medical research. We do not provide individualized advice.