Exploring Network Meta-Analyses (NMA) in Psoriasis

This episode, titled "Exploring Network Meta-Analyses (NMA) in Psoriasis," features panelists discussing the value and limitations of network meta-analyses as a tool for comparing multiple psoriasis therapies across different clinical trials simultaneously.

The panel opens by introducing a network meta-analysis presented at a 2026 meeting that evaluated icotrokinra against multiple biologic and oral therapies. The panel explains that while NMAs allow for a broader range of comparisons than a single MAIC, the data they generate provides a range of where a drug's efficacy is likely to fall rather than a definitive declaration of superiority over any individual comparator. In this particular analysis, icotrokinra demonstrated superiority over placebo, deucravacitinib, adalimumab, apremilast, and ustekinumab. It showed comparable performance to secukinumab, guselkumab, risankizumab, and ixekizumab, while bimekizumab and brodalumab outperformed icotrokinra in this analysis.

The panel then outlines the key methodological limitations of NMAs compared to MAICs. Unlike MAICs, NMAs do not adjust for differences in patient population demographics across studies, relying instead on assumptions that treatment effects would have behaved similarly across different trial populations. The panel cautions that higher placebo response rates in one study can make a drug appear less effective, and that overlapping confidence intervals in an NMA do not necessarily mean two drugs are equivalent, citing examples where head to head trials have subsequently demonstrated clear superiority of one agent over another despite NMA results suggesting comparability.

The panel concludes by acknowledging that both MAICs and NMAs have inherent limitations including known and unknown demographic confounders, and that head to head trials remain the gold standard for drug comparisons. However, given the significant resources required to power head to head trials sufficiently, particularly in a field where leading therapies perform at very high levels, these indirect comparison tools remain important and valuable pieces of the overall evidence puzzle.

In the next episode, "Evaluating IL-23 Inhibitors with Long-Term Data and Real-World Evidence," panelists will continue their discussion on psoriasis and highlight the complementary roles of long term extension studies and real world evidence in assessing the durability and safety of IL-23 inhibitors, and why real world data is critical for understanding how these therapies perform outside of the controlled clinical trial setting.