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Guselkumab, Secukinumab, and Brodalumab rank highly for PASI 75 and PASI 90 in plaque psoriasisNew data ranks different treatments for moderate to severe psoriasis

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Key Takeaway
Note that Guselkumab, Secukinumab, and Brodalumab rank highly for PASI 75 and PASI 90 in plaque psoriasis.

This systematic review and network meta-analysis evaluated the comparative efficacy and safety of IL-23/IL-17 inhibitors (Guselkumab, Secukinumab, Brodalumab, and Tildrakizumab) for patients with moderate-to-severe plaque psoriasis. The analysis included 27 RCTs from 23 different publications to rank these agents against placebo and other inhibitors.

For the primary outcomes of PASI 75 and PASI 90, Guselkumab 200 mg, Secukinumab 300 mg, and Brodalumab 210 mg were ranked highly. Regarding secondary outcomes, Tildrakizumab 100 mg and Tildrakizumab 200 mg demonstrated high SUCRA values for cleared or almost cleared skin and reduction in DLQI scores.

Safety data are limited by non-uniform reporting across the included trials. Specifically, Brodalumab 140 mg at 12 weeks showed a risk ratio of 1.12 (95% CrI: 1.03, 1.23), and Secukinumab 150 mg showed a risk ratio of 1.22 (95% CrI: 1.09, 1.35). Because rankings varied across different outcomes and follow-up durations, these results provide regimen-specific evidence for short-term efficacy but should be interpreted with caution regarding long-term safety profiles.

How this fits prior evidence

This network meta-analysis extends prior evidence regarding IL-17 inhibitors, which were previously noted to rank highly for the clearance of scalp, nail, and palmoplantar psoriasis. While previous data highlighted secukinumab, bimekizumab, and ixekizumab for difficult-to-treat sites, this study adds comparative rankings for Guselkumab, Brodalumab, and Tildrakizumab in broader plaque psoriasis outcomes like PASI 75 and PASI 90.

Living with moderate to severe plaque psoriasis can be a daily struggle, affecting both physical comfort and emotional well-being. New research compared four specific types of treatments called IL-23 and IL-17 inhibitors. These are medications designed to calm the immune system's overreaction in the skin.

The study looked at 27 clinical trials to see how these drugs performed. For clearing skin, Guselkumab, Secukinumab, and Brodalumab ranked highly. When looking specifically at patients who achieved clear or almost cleared skin and improved quality of life scores, Tildrakizumab showed high performance.

While the results are promising, some details are still fuzzy. Because different trials reported side effects in different ways, it is hard to say exactly how safe each drug is compared to the others. These findings help doctors choose a specific plan based on what works best for a patient's skin and lifestyle.

What this means for you:
Different biologics show varying success rates in clearing skin and improving life quality for psoriasis patients.

Common questions

Which medications were most effective at clearing skin?

The study found that Guselkumab (200 mg), Secukinumab (300 mg), and Brodalumab (210 mg) ranked highly for achieving PASI 75 and PASI 90, which are measures of how much skin clears up. Tildrakizumab at both 100 mg and 200 mg also showed high performance in helping patients achieve clear or almost cleared skin.

Are these treatments safe for people with psoriasis?

The study noted some side effects, such as Brodalumab 140 mg and Secukinumab 150 mg. However, because different trials reported safety data in different ways, the results are not uniform. You should talk to your doctor to understand the specific risks and benefits of each medication for your personal health.

How does Tildrakizumab compare to other options?

Tildrakizumab at 100 mg and 200 mg showed high values for clearing skin and improving Dermatology Life Quality Index scores. This means it performed well in helping patients feel better and have clearer skin compared to some other treatments in the study.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Psoriasis is a relapsing inflammatory skin disease that significantly impacts patients' quality of life, particularly those with moderate-to-severe lesions, which also impose considerable psychological stress. Biologics have become a primary therapeutic approach for moderate-to-severe plaque psoriasis. This study aims to evaluate the clinical efficacy and safety of biologics, providing guidance for clinical application. We searched PubMed, Cochrane Library, EMBASE, and Web of Science from inception to May 29, 2024, and conducted an updated supplementary search from May 30, 2024 to April 25, 2026 to identify randomized controlled trials (RCTs) assessing the efficacy and safety of IL-23/IL-17 inhibitors in treating moderate-to-severe plaque psoriasis. The quality of the included studies was evaluated using the Cochrane risk of bias tool, and a meta-analysis was performed using R software (version 4.3.1). A total of 23 publications were included after screening, comprising 27 RCTs that were incorporated into the network meta-analysis. The meta-analysis results showed that several regimens, including Guselkumab 200 mg, Secukinumab 300 mg, and Brodalumab 210 mg, ranked highly for PASI 75 and PASI 90 at specific follow-up time points; however, ranking patterns varied across outcomes and follow-up durations. Additionally, Tildrakizumab 100 mg and Tildrakizumab 200 mg showed high SUCRA values for achieving cleared or almost cleared skin and reducing the Dermatology Life Quality Index (DLQI) score at most follow-up time points. In short-term safety analyses, some agents showed a higher incidence of adverse events compared to placebo, including Brodalumab 140 mg at 12 weeks [RR = 1.12, 95%CrI = (1.03, 1.23)] and Secukinumab 150 mg [RR = 1.22, 95% CrI = (1.09, 1.35)]. However, adverse-event reporting was not uniformly comprehensive across all included trials, and these findings should therefore be interpreted with caution. This network meta-analysis provides regimen-specific comparative evidence for short-term efficacy and safety of IL-23/IL-17 inhibitors. Treatment rankings should be interpreted within each outcome and follow-up time point, together with effect estimates, safety profiles, and the amount of supporting evidence. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024584441.
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