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Introduction <p>Recent trials with withdrawal arms in patients with psoriasis have highlighted the need for updated clinical guidance. The aim of this investigation was to compare the effects and safety of planned limited-time withdrawal versus continuous maintenance of interleukin (IL) inhibitors in patients with psoriasis.</p> Methods <p>On August 5, 2025, the following platforms were systematically searched: PubMed, Embase, Clarivate (Web of Science), Scopus, and Ovid. Titles and abstracts, followed by full-text articles, were independently screened by two reviewers, with any disagreements being resolved by a third reviewer. Certainty of evidence was evaluated via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Network meta-analyses for the Psoriasis Area and Severity Index (PASI) 90 and PASI100 outcomes were performed. The risk ratio (RR) of relapse was ranked using the surface under the cumulative ranking curve (SUCRA) metric.</p> Results <p>A total of 7444 records were retrieved, 54 of which included data from 18 different trials. The data revealed a total of 2995 patients who were subjected to anti-IL withdrawal regimens that were eligible for comparison with anti-IL maintenance. For the PASI90 outcome, the network meta-regression, adjusted for a post-withdrawal follow-up duration of 40–48&#xa0;weeks, indicated that bimekizumab demonstrated a RR for relapse (RR 5.36; 95% confidence interval (CI) 3.45–8.34; SUCRA 0.685) comparable to that of guselkumab (RR 7.45; 95%&#xa0;CI 4.97–11.19; SUCRA 0.412) and lower than that of ixekizumab (RR 17.45; 95%&#xa0;CI 10.22–29.80; SUCRA 0.006). No significant difference in adverse event rates was observed between the anti-IL withdrawal and maintenance groups.</p> Conclusions <p>Compared with continued treatment, planned withdrawal of anti-IL therapy is associated with a largely superior risk of relapse, without any reduction in the incidence of adverse events. Moreover, bimekizumab withdrawal demonstrated better outcomes than ixekizumab withdrawal did according to the PASI90 outcome.</p> Study Registration <p>This study was prospectively registered on PROSPERO (identification number CRD420251118724).</p>

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Comparison of the Effects and Safety of Planned Limited-Time Withdrawal Versus Continuous Maintenance of Interleukin Inhibitors in Patients with Psoriasis: A Systematic Review and Network Meta-Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月18日

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  • Rodrigo R. de Sena,
  • Kleyton de C Mesquita,
  • Letícia F. Barroso,
  • Paola B. E. Canabrava,
  • Fernando Zanghelini,
  • Ciro M. Gomes

摘要

Introduction

Recent trials with withdrawal arms in patients with psoriasis have highlighted the need for updated clinical guidance. The aim of this investigation was to compare the effects and safety of planned limited-time withdrawal versus continuous maintenance of interleukin (IL) inhibitors in patients with psoriasis.

Methods

On August 5, 2025, the following platforms were systematically searched: PubMed, Embase, Clarivate (Web of Science), Scopus, and Ovid. Titles and abstracts, followed by full-text articles, were independently screened by two reviewers, with any disagreements being resolved by a third reviewer. Certainty of evidence was evaluated via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Network meta-analyses for the Psoriasis Area and Severity Index (PASI) 90 and PASI100 outcomes were performed. The risk ratio (RR) of relapse was ranked using the surface under the cumulative ranking curve (SUCRA) metric.

Results

A total of 7444 records were retrieved, 54 of which included data from 18 different trials. The data revealed a total of 2995 patients who were subjected to anti-IL withdrawal regimens that were eligible for comparison with anti-IL maintenance. For the PASI90 outcome, the network meta-regression, adjusted for a post-withdrawal follow-up duration of 40–48 weeks, indicated that bimekizumab demonstrated a RR for relapse (RR 5.36; 95% confidence interval (CI) 3.45–8.34; SUCRA 0.685) comparable to that of guselkumab (RR 7.45; 95% CI 4.97–11.19; SUCRA 0.412) and lower than that of ixekizumab (RR 17.45; 95% CI 10.22–29.80; SUCRA 0.006). No significant difference in adverse event rates was observed between the anti-IL withdrawal and maintenance groups.

Conclusions

Compared with continued treatment, planned withdrawal of anti-IL therapy is associated with a largely superior risk of relapse, without any reduction in the incidence of adverse events. Moreover, bimekizumab withdrawal demonstrated better outcomes than ixekizumab withdrawal did according to the PASI90 outcome.

Study Registration

This study was prospectively registered on PROSPERO (identification number CRD420251118724).