Efficacy and safety of interleukin inhibitors in the treatment of moderate-to-severe plaque psoriasis: a systematic review and network meta-analysis.

BACKGROUND: 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. METHODS: 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). RESULT: 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. CONCLUSION: 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. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024584441.