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
6 affiliations
- 1Internal Medicine, Ministry of Health, Irbid, JOR
- 2Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
- 3Medicine and Surgery, University of Jordan, Amman, JOR
- 4School of Medicine, IMU University, Seremban, MYS
- 5Faculty of Medicine, International University of the Health Sciences, Basseterre, KNA
- 6Faculty of Medicine, Mutah University, Karak, JOR
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 class-level 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-one-out analyses showed marked small-sample instability. These findings are hypothesis-generating and do not establish comparative superiority.
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BibTeX
@article{migdady2026adjusted,
title = {{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}},
author = {Deya S Migdady and Nooran Alshyyab and Hashem M Alkhalaileh and Zi Yong Goh and Yael Reingold and Omar Rababah and Tala M Zghayer and Yousef Alsalhi and Abdelrahman K Alsaidi and Mustafa G Alrabbai},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117280},
url = {https://europepmc.org/article/PMC/PMC13723324},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Deya S Migdady
AU - Nooran Alshyyab
AU - Hashem M Alkhalaileh
AU - Zi Yong Goh
AU - Yael Reingold
AU - Omar Rababah
AU - Tala M Zghayer
AU - Yousef Alsalhi
AU - Abdelrahman K Alsaidi
AU - Mustafa G Alrabbai
PY - 2026
DA - 2026/10/01
JO - Cureus
DO - 10.7759/cureus.117280
UR - https://europepmc.org/article/PMC/PMC13723324
AB - 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 class-level 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-one-out analyses showed marked small-sample instability. These findings are hypothesis-generating and do not establish comparative superiority.
SN - 2168-8184
ER -