Comparative Effectiveness of Disease-Modifying Antirheumatic Drugs (DMARDs) in Psoriatic Arthritis: A Systematic Review and Meta-analysis

Introduction: The comparative effectiveness of DMARDs in psoriatic arthritis is of paramount clinical importance, given the disease’s heterogeneity and the expanding range of therapeutic options. Evaluating and synthesizing evidence across multiple agents helps guide personalized, evidence-based treatment decisions, supports optimal therapeutic sequencing, and informs treat-to-target strategies. Material and methods: This systematic review and meta-analysis rigorously evaluated the comparative efficacy and safety of DMARDs in psoriatic arthritis by comprehensively searching multiple databases for RCTs and observational studies. Methodological quality and risk of bias were assessed using validated tools, with data independently extracted by reviewers. Statistical heterogeneity was quantified and explored through subgroup analyses, applying random-effects models when appropriate to ensure robust, generalizable conclusions for clinical decision-making.Results: This systematic review included eight studies selected from ۱,۲۴۳ identified records, assessing the comparative effectiveness and safety of csDMARDs, bDMARDs, and tsDMARDs in psoriatic arthritis. Pooled efficacy outcomes showed superior ACR and PASI responses with bDMARDs and tsDMARDs compared to csDMARDs. Adverse event rates were highest with tsDMARDs, particularly for serious events, while csDMARDs had higher withdrawal rates. Findings underscore differences in therapeutic profiles across DMARD classes.Conclusion: Based on this systematic review, biologic DMARDs demonstrated superior efficacy in ACR and PASI response rates compared to conventional and targeted synthetic DMARDs, with an acceptable safety profile. Targeted synthetic DMARDs showed intermediate efficacy but higher rates of serious adverse events. Conventional DMARDs were less effective overall. These findings support the preferential use of biologic agents in moderate-to-severe disease, safety factors.

کلیدواژه ها:

psoriatic arthritis ، DMARDs (Disease-Modifying Antirheumatic Drugs) ، Comparative Effectiveness ، systematic review and meta-Analysis