Summary of recommendations and bias risk by class in RCTs of PsA, from 2013 to 2021.
| Class | Study | Bias Riska | Effect by Class | Recommendation for Treatment | Comments |
|---|---|---|---|---|---|
| PDE4i | PALACE 1 | N | Favor PDE4i | Strong for | Efficacy overall less than most biologics; studies lack active comparator |
| PALACE 2 | N | ||||
| PALACE 3 | N | ||||
| PALACE 4 | N | ||||
| JAKi/TYK2i | OPAL Beyond | N | Favor JAKi | Strong for | Most countries without regulatory approval for psoriasis for JAKi, TYK2i |
| OPAL Broaden | N | ||||
| EQUATOR | N | ||||
| NCT03881059 | N | ||||
| SELECT-PsA 1 | N | ||||
| SELECT-PsA 2 | N | ||||
| TNFi | RAPID-PsA | N | Favor TNFi | Strong for | Studies prior to 2013 not included in analysis; regulatory approval for CZP dosing in psoriasis different than PsA |
| GO-VIBRANT | N | ||||
| GO-DACT | Y | ||||
| SPIRIT-P1 - ADA | N | ||||
| OPAL Broaden ADA | N | ||||
| SELECT-PsA 1 ADA | N | ||||
| IL-12/23i | PSUMMIT 1 | N | Favor IL-12/23i | Strong for | Regulatory approval for both psoriasis and PsA |
| PSUMMIT 2 | N | ||||
| IL-23i | NCT02319759 | N | Favor IL-23i | Strong for | TIL without regulatory approval for PsA |
| DISCOVER- 1 | N | ||||
| DISCOVER- 2 | N | ||||
| KEEPsAKE 1 | N | ||||
| KEEPsAKE 2 | N | ||||
| NCT02980692 | N | ||||
| IL-17i | SPIRIT-P1 | N | Favor IL-17i | Strong for | Regulatory approval for psoriasis but not PsA in some countries; approved dosing for SEC for psoriasis differs from PsA |
| SPIRIT-P2 | N | ||||
| FUTURE 1 | N | ||||
| FUTURE 2 | N | ||||
| FUTURE 3 | N | ||||
| FUTURE 4 | N | ||||
| FUTURE 5 | N | ||||
| BE ACTIVE | N | ||||
| NCT02141763 | Y | ||||
| AMVISION-1/2 | N | ||||
| CTLA4Igi | ASTRAEA | Y | No efficacy over PBO | No recommendation | Single small study; lack of efficacy over PBO |
↵a Overall risk of serious bias (Y = yes, N = no, for serious risk of bias) based on summary of risk assessment considering limitations, inconsistency, indirectness, publication bias. ADA: adalimumab; ASTRAEA: Active Psoriatic Arthritis Randomized Trial; CTLA4Igi: cytotoxic T-lymphocyte-associated protein 4-immunoglobulin g inhibitor; CZP: certolizumab pegol; IL-12/23i: interleukin 12/23 inhibitor; JAKi: Janus kinase inhibitor; OPAL: Opal Psoriatic Arthritis Trial; PALACE: Psoriatic Arthritis Long-term Assessment of Clinical Efficacy; PBO: placebo; PDE4i: phosphodiesterase 4 inhibitor; PsA: psoriatic arthritis; RCT: randomized controlled trial; SEC: secukinumab; TIL: tildrakizumab; TNFi: tumor necrosis factor-α inhibitor; TYK2i: tyrosine kinase 2 inhibitor.