Background: Moderate-to-severe plaque psoriasis is a chronic inflammatory skin condition affecting approximately 2-3% of the world’s population, characterized by red, scaly plaques causing substantial impairment in quality of life. Multiple biologic agents targeting different inflammatory pathways are available, including tumor necrosis factor-alpha (TNF-α), interleukin-12/23 (IL-12/23), interleukin-17 (IL-17), and interleukin-23 (IL-23) inhibitors. While previous network meta-analyses have compared biologics, most were conducted before the approval of bimekizumab, the newest dual IL-17A/F inhibitor, and lack head-to-head comparisons incorporating this agent alongside contemporary biologic therapies.

Methods: We conducted a systematic review and frequentist random-effects network meta-analysis of phase III randomized controlled trials comparing biologic treatments for moderate-to-severe plaque psoriasis. Searches were performed in PubMed and ClinicalTrials.gov. The primary outcome was achievement of PASI 90 (≥90% reduction in Psoriasis Area and Severity Index score) at week 16. Odds ratios (OR) with 95% confidence intervals (CI) and P-scores were calculated for all treatment comparisons using the netmeta package in R. Results: Eleven phase III RCTs (10 datasets, 6,657 patients) were included, comparing bimekizumab, secukinumab, risankizumab, guselkumab, adalimumab, ustekinumab, and placebo. All active treatments demonstrated significant superiority over placebo. The efficacy hierarchy was: bimekizumab (OR 170.04, 95% CI 104.33-277.14, P-score 0.00), risankizumab (OR 95.40, P-score 0.21), guselkumab (OR 82.25, P-score 0.35), secukinumab (OR 75.01, P-score 0.44), adalimumab (OR 30.07, P-score 0.71), and ustekinumab (OR 26.68, P-score 0.79). Bimekizumab demonstrated statistically significant superiority over all other active comparators. Network heterogeneity was very low (I² = 0.0%), and no significant inconsistency was detected between direct and indirect evidence.

Conclusions: Bimekizumab achieves the highest efficacy for PASI 90 response at week 16 among currently available biologic therapies. Risankizumab, guselkumab, and secukinumab form a cluster of highly effective treatments with comparable efficacy, all substantially superior to adalimumab and ustekinumab. These findings support evidence-based treatment selection for moderate-to-severe plaque psoriasis and highlight the clinical advantage of newer biologic agents, particularly dual IL-17A/F inhibition. Treatment choice should integrate efficacy data with considerations of dosing convenience, safety profiles, and individual patient circumstances

Abdullah Abdullah is an Internal Medicine Trainee at Newham University Hospital, Barts Health NHS Trust, London. He graduated from the College of Medicine, University of Baghdad in 2015 and holds MRCP Parts 1 and 2. He has broad clinical experience across internal medicine and dermatology, having trained in both the UK and Iraq. His research interests span inflammatory and infectious dermatological conditions, with published case reports in pemphigus vulgaris and fungal cellulitis, as well as cross-sectional studies examining tinea infections and pityriasis versicolor. He has conducted a network meta-analysis comparing biologic therapies for moderate-to-severe plaque psoriasis, evaluating IL-17 and IL-23 inhibitors across Phase III randomised controlled trials — the findings of which are presented at this conference.