SYSTEMATIC REVIEW article
Front. Med.
Sec. Dermatology
The correlation between biological agents and comorbidities of moderate to severe plaque psoriasis: a network meta-analysis of randomized controlled trials
Provisionally accepted
- Shengjing Hospital of China Medical University, Shenyang, China
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Objective: This paper aims to evaluate the association between biologics and comorbidities related to psoriasis, using a frequency-based reticulated meta-analysis. Methods: The researchers searched the following databases: Web of Science, PubMed, Excerpta Medical Database (Embase), Cochrane Library, China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform, China Biology Medicine disc (CBMdisc). Besides, the researchers collected all randomized controlled trials (RCTs) of biological agents for moderate to severe plaque psoriasis from the establishment of the database until July1, 2025. After two researchers independently screened literature, extracted data, and evaluated the risk of bias in the included studies, a net meta-analysis was conducted using Stata 16.0 software. Results: Fifty-two RCTs involving thirteen biologics and a total of 29,251 patients were included. Net meta-analysis manifested that mirikizumab was associated with a lower reported incidence of coronary heart disease(CHD), hyperlipidemia , depression and arthritis, ranked first in SUCRA. Brodalumab was associated with a lower incidence of hyperuricemia, ranked first in SUCRA. Guselkumab was associated with a lower incidence of anxiety, ranked second in SUCRA. Subgroup analysis of therapeutic targets revealed that IL-23 inhibitors were associated with a lower incidence of stroke, hyperlipidemia, hyperglycemia, anxiety and arthritis, ranked first in SUCRA (except for ranking second in anxiety). Conclusion: This study analyzed aggregated RCTs and found that, compared with other biologics, mirikizumab, brodalumab, and guselkumab were associated with a lower incidence of specific psoriasis comorbidities. Subgroup analyses revealed that IL-23 inhibitors and IL-17 inhibitors were associated with a lower incidence of specific psoriasis comorbidities. These findings stem from adverse event reports in short-to medium-term RCTs, which lack sufficient statistical power to evaluate outcomes related to psoriasis complications. Therefore, this conclusion should be regarded as a hypothesis-driven inference requiring validation through future targeted long-term outcome studies.
Keywords: Psoriasis, Biological Agents, IL-23 inhibitors, IL-17 inhibitors, TNF-αinhibitors, Comorbidity, Network meta-analysis
Received: 04 Sep 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Li, Han and Mu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiuping Han, hanxiuping66@126.com
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