Work

Adjusted Comparative Treatment Persistence of IL-23p19 Versus IL-17 Pathway Inhibitors in Adults With Plaque Psoriasis: A Systematic Review and Exploratory Meta-analysis of Real-World Time-to-Discontinuation Estimates

Year: 2026

Type: review

Abstract: Long-term biologic persistence is a clinically relevant real-world outcome in plaque psoriasis because it reflects sustained effectiveness, tolerability, acceptability, treatment burden, and access beyond short-term trial efficacy.We systematically reviewed adjusted real-world comparisons of treatment discontinuation between IL-23p19 inhibitors and IL-17 pathway inhibitors.We searched PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Google Scholar from inception through August 8, 2026.Among 1,672 imported records, 580 duplicates were removed, 1,092 records were screened, 31 reports were sought, and 21 full texts were assessed.Six studies met the eligibility criteria; three provided adjusted time-to-event estimates for quantitative synthesis.Because only three observational studies contributed and one estimate was classlevel whereas two were drug-level, the quantitative result is exploratory, and the certainty of evidence is very low.A random-effects restricted maximum likelihood (REML) model with Hartung-Knapp adjustment yielded a pooled standardized hazard ratio (HR) for discontinuation of 0.34 (95% CI 0.12-0.94;p = 0.045), with substantial heterogeneity (I² = 76.7%;τ² = 0.129) and a 95% prediction interval that crossed the null (approximately 0.05-2.16).The direction of effect favored IL-23p19 therapy across the three estimates, but magnitude varied.Drug-level sensitivity substitutions reduced estimated heterogeneity, while leave-oneout analyses showed marked small-sample instability.These findings are hypothesis-generating and do not establish comparative superiority.

Source: Cureus

DOI: 10.7759/cureus.117280