Systematic review and network meta-analysis of biologics and small molecules for scalp psoriasis.
I-Chang Lai, Kuan-Chun Lee, Guan-Lun Huang et al.
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In 30 seconds
This systematic review and network meta-analysis compared short-term efficacy, safety and tolerability of biologics and small molecules for scalp psoriasis, using randomized controlled trials. Sixteen trials involving 10,266 patients were included. At Weeks 12–16, all active treatments improved scalp clearance versus placebo; ixekizumab every 2 weeks and brodalumab ranked highest, with odds ratios of 54.02 (95% CI 39.38-74.09) and 53.16 (95% CI 15.47-182.69), respectively. Serious adverse event risks were not significantly increased for any intervention. Guselkumab was described as having a favourable balance of efficacy, safety and tolerability.
Key findings
- Ixekizumab every 2 weeks ranked highest for scalp clearance (OR 54.02; 95% CI 39.38-74.09), followed by brodalumab (OR 53.16; 95% CI 15.47-182.69).
- All active agents significantly improved scalp clearance versus placebo at Weeks 12–16.
- Serious adverse event risks were non-significant across interventions; apremilast alone significantly increased discontinuation due to adverse events (OR 1.62; 95% CI 1.09-2.42).
- Guselkumab was reported to have a favourable balance of efficacy, safety and tolerability.
Why it matters
Scalp psoriasis can be difficult to treat, and comparative evidence specific to this manifestation has been limited. These pooled comparisons help distinguish short-term scalp-clearance performance among systemic options while also considering adverse events and treatment discontinuation. The findings may support more informed discussions of treatment trade-offs, although they do not establish comparative long-term outcomes.
What to keep in mind
The analysis addresses short-term outcomes at Weeks 12–16; the abstract does not report longer-term comparative evidence.