Evaluating Psoriasis Therapies using MAICs

In "Evaluating Psoriasis Therapies using MAICs," our panel delves into several recent and clinically meaningful MAIC analyses comparing biologic therapies for plaque psoriasis, examining what the data reveals about relative efficacy across treatment classes and how these analyses have been validated over time.

The panel opens by discussing a recently presented anchored MAIC comparing risankizumab to icotrokinra, an oral IL-23 receptor blocker not yet approved for psoriasis. Using risankizumab patient level data matched to icotrokinra's aggregate demographic data and adjusted for placebo response, the analysis demonstrated statistically significant superiority for risankizumab across PASI 75, 90, and 100 endpoints at weeks 4, 8, 12, and 16. The panel is careful to note that icotrokinra performed well overall, and that the superiority observed reflects the rigor of the adjusted analysis rather than a dismissal of the comparator drug.

The discussion then broadens to cover three additional MAICs conducted across different biologic classes. The first compared risankizumab to deucravacitinib, a TYK2 inhibitor, showing risankizumab superiority with a 32 to 40% delta across PASI 75, 90, and 100 endpoints. The second compared deucravacitinib to adalimumab using long term extension data rather than a placebo controlled period, demonstrating a 10 to 13% delta favoring deucravacitinib at approximately two years. The third compared guselkumab to ixekizumab over three years, finding that while the IL-17 inhibitor ixekizumab performed faster initially, guselkumab not only caught up but appeared to outperform it in the long run.

The panel highlights that the true validation of the MAIC methodology lies in the fact that dedicated head to head trials subsequently conducted for both risankizumab versus deucravacitinib and guselkumab versus ixekizumab confirmed the findings predicted by the earlier MAIC analyses. The panel also acknowledges important methodological considerations for long term MAICs, including the absence of a placebo group, population enrichment over time, and the challenge of handling missing data, while noting that certain study designs used multiple statistical analyses and placebo crossover patients to strengthen the robustness of their conclusions.

Our next episode, "Exploring Network Meta-Analyses (NMA) in Psoriasis," further explores psoriasis highlighting the utility and limitations of network meta-analyses as a complementary statistical tool for comparing multiple biologic and oral therapies simultaneously, and how findings from a recent NMA evaluating icotrokinra against several available treatments help contextualize its place within the broader IL-23 treatment landscape.