Twenty trials, with over 10,000 patients, were included in the review; sample sizes ranged from 22 to 1,230 patients. There were three trials of adalumimab, five of efalizumab, five of etanercept, four of infliximab, and three of ustekinumab; only one trial was a comparison of treatments, the rest were placebo controlled. All trials were of high quality (Jadad scores ranged from 3 to 5).
For the PASI 50 (Psoriasis Area and Severity Index 50%) outcome, infliximab was found to be the most effective treatment when compared with placebo (RR 7.3, 95% CrI 6.6 to 8.1). This was followed by ustekinumab 90mg (RR 7.1, 95% CrI 6.5 to 7.8), adalimumab (RR 6.4, 95% CrI 5.7 to 7.1), etanercept 50mg (RR 6.0, 95% CrI 5.4 to 6.6), and efalizumab (RR 4.0, 95% CrI 3.5 to 4.5). The ordering of treatments was the same for the PASI 75 and PASI 90 outcomes. There was a 93% probability that infliximab was the most effective treatment.