Efficacy and safety of newer topical therapies in psoriasis: A systematic review and network meta-analysis.

Psoriasis is a chronic immune-mediated skin disease. Several clinical trials have studied some topical drugs aiming at new therapeutic targets. However,the comparative efficacy and safety of different concentrations and frequencies of newer topical drugs for psoriasis remain unclear.The aim of our study is to assess the comparative efficacy and safety of some newer topical treatments in patients with psoriasis. A systematic review and network meta-analysis (NMA) was conducted using eligible randomized controlled trials (RCTs). Treatments included topical therapeutic aryl hydrocarbon receptor(AhR)-modulating agent(TAMA), topical phosphodiesterase type 4 (PDE‑4) inhibitors and topical janus kinase-signal transducer and activator of transcription(JAK-STAT) inhibitors. The primary efficacy assessment criteria was the proportion of patients' achieving Physician's Global Assessment 0/1 (PGA response). Secondary criteria was≥75 % reductions in Psoriasis Area and Severity Index (PASI 75). Adverse events (AEs) to represent the safety were also summarized. Among 6 including newer topical drugs, odds of achieving both PGA response and PASI 75 were higher with all regimen of TAMA and roflumilast cream versus vehicle. In terms of safety outcomes, odds of AEs was also higher with all regimen of TAMA. There were no statistically significant differences between topical JAK-STAT inhibitors and vehicle for any outcome, except ruxolitinib ointment 1% once daily (QD). TAMA had a good therapeutic effect on plaque psoriasis but a relatively low treatment safety. Roflumilast cream had both promising efficacy and higher safety.

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