Clinical Question

What are the most effective treatments for moderate to severe plaque psoriasis?

Evidence-Based Answer

Infliximab, bimekizumab (Bimzelx), ixekizumab (Taltz), and risankizumab (Skyrizi) are the most effective medications for achieving a 90% reduction in symptoms among patients with moderate to severe plaque psoriasis.¹ (Strength of Recommendation: A, consistent, good-quality patient-oriented evidence.)

Practice Pointers

Psoriasis is a chronic, immune-mediated inflammatory disorder involving the skin and other organ systems. It affects an estimated 3.2% of people older than 20 years in the United States.² Psoriasis can present significant challenges due to its variable clinical manifestations, potential for comorbidities, and the evolving landscape of treatment options.³

This Cochrane review included 179 randomized controlled trials with a total of 62,339 participants and evaluated 20 unique treatments.¹ The patient population included adults older than 18 years with moderate to severe plaque psoriasis. The Psoriasis Area and Severity Index (PASI) score was used to assess psoriasis severity (range = 0 to 72, with a score of 5 to 10 indicating moderate disease and a score greater than 10 indicating severe disease). The PASI instrument is completed by examiners, and the score considers the extent and severity of skin involvement, including factors such as redness, scaling, and thickness of psoriatic lesions in four body regions (i.e., head, upper extremities, trunk, and lower extremities). PASI 90 describes when a patient has symptoms of psoriasis that have improved by 90% or more compared with their initial baseline PASI score and is, therefore, a measure of treatment effectiveness. Of the studies included in this review, 56% were placebo-controlled, and at least 77% were industry-sponsored.