Short-term efficacy of biologics targeting the IL-17/IL-23 axis in scalp, nail, and palmoplantar psoriasis: a network meta-analysis of randomized controlled trials
In brief
Secukinumab ranks best for palm-plantar psoriasis clearance among biologics
In a network meta-analysis of 24 trials (5,946 patients), secukinumab achieved the highest probability of complete or near-complete clearance of palm-plantar lesions, while bimekizumab and ixekizumab were top performers for nail and scalp disease. IL-17 inhibitors overall showed the strongest short-term results, but evidence certainty varies and long-term outcomes remain unknown.
- Journal
- Frontiers in immunology (Q1)
- Published
- 22 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Shouxu Zhang, TszLeong Lam, Yue Du, Xiaoxuan Chen, Haomin Zhang, Lingling Li, et al.
- PMID
- 42558790
- DOI
- 10.3389/fimmu.2026.1846290
Why clinicians should know about it
- Picked for Immunology and Allergy (top studies of the week, 9 August 2026).
- Picked for Anatomy (top studies of the week, 9 August 2026).
- Picked for Dermatology (top studies of the week, 9 August 2026): Biologics for difficult psoriasis sites
- Picked for Public Health, Environmental and Occupational Health (top studies of the week, 9 August 2026).
Abstract
BACKGROUND: Scalp, nail, and palmoplantar psoriasis are termed "difficult-to-treat sites" owing to their unique anatomical features and therapeutic resistance, substantially impairing patient quality of life. Although anti-IL-17 and anti-IL-23 biologics are widely used, head-to-head comparative evidence for achieving high-level lesion clearance at these specific sites remains limited. METHODS: Following PRISMA-NMA guidelines, we systematically searched PubMed, Embase, and other databases from inception through November 2025 for randomized controlled trials (RCTs). Primary outcomes were defined as complete or near-complete clearance. Frequentist network meta-analysis was performed to calculate odds ratios (ORs), with treatment rankings derived from surface under the cumulative ranking curve (SUCRA) values. RESULTS: Twenty-four RCTs involving 5,946 patients and eight biologics plus placebo were included. For palmoplantar psoriasis, secukinumab ranked highest (SUCRA = 79.7%), followed by bimekizumab (72.2%) and ustekinumab (69.7%). For nail psoriasis, bimekizumab ranked first (78.9%), followed by ixekizumab (77.2%) and brodalumab (67.5%); however, local inconsistency for the ixekizumab-placebo comparison and low-certainty evidence warrant caution. For scalp psoriasis, brodalumab (87.7%) and ixekizumab (86.9%) ranked highest, followed by bimekizumab (69.0%) and guselkumab (65.1%); the brodalumab estimate relied on a single contributing study. CONCLUSION: During induction-phase follow-up, IL-17 inhibitors tended to rank highly for complete or near-complete clearance at difficult-to-treat psoriasis sites. Bimekizumab and ixekizumab showed consistently favorable rankings across sites, but treatment selection should consider certainty of evidence, sensitivity analyses, long-term response, and patient-level factors. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, identifier CRD420251271255.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.