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Vergleich der Wirksamkeit und Sicherheit von Biologika zur Behandlung mittelschwerer bis schwerer Plaque-Psoriasis im Kindes- und Jugendalter, soweit diese von der US Food and Drug Administration (FDA) und der European Medicines Agency (EMA) zugelassen sind.Die Datenbanken MEDLINE, Embase und Cochrane Central Register of Controlled Trials wurden im Zeitraum bis 7. Mai 2021 nach relevanten randomisierten, kontrollierten Studien (RCT, randomized controlled trials) durchsucht. Eine Fixed-Effect-Netzwerk-Metaanalyse (NMA) wurde durchgeführt, wobei für die Rangfolge die SUCRA (surface under the cumulative ranking curve) berechnet wurde. Die primären Endpunkte waren die Verbesserung des Psoriasis Area and Severity Index Score um ≥ 90 % (PASI 90) nach 12-16 Wochen sowie das Ausscheiden aufgrund von Nebenwirkungen (DAE, discontinuation owing to adverse events) im Laufe der ersten 12-16 Wochen.Fünf RCT mit insgesamt 798 pädiatrischen Psoriasis-Patienten wurden in unsere Analyse einbezogen. Sämtliche untersuchten Biologika zeigten im Vergleich zu Placebo signifikant verbesserte PASI 90-Werte, während das Risiko für DAE keinen Unterschied zu Placebo aufwies. Basierend auf der SUCRA erreichte Secukinumab in der niedrigeren Dosierung (SEC-L) das beste Ansprechen im PASI 90 (84,7 %), gefolgt von Ixekizumab (70,8 %).Unter allen eingeschlossenen Biologika konnte mit SEC-L das beste Ansprechen im PASI 90 erreicht werden, ohne das Risiko für DAE zu erhöhen. Weitere Langzeitstudien sollten folgen.

To compare the efficacy and safety of biologic treatments for moderate-to-severe pediatric psoriasis approved by the US Food and Drug Administration and European Medicines Agency.MEDLINE, Embase, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials (RCTs) were searched for the identification of eligible RCTs until May 7, 2021. Fixed-effect frequentist network meta-analysis (NMA) was performed with the surface under the cumulative ranking curve (SUCRA) calculated for ranking. Our primary outcomes included ≥ 90 % improvement of Psoriasis Area and Severity Index score (PASI 90) at 12-16 weeks and discontinuation owing to adverse events (DAE) through the first 12-16 weeks.Five RCTs involving 798 pediatric psoriasis patients were included. Compared to placebo, all biologic regimens exhibited a significantly higher PASI 90 response but did not differ in the risk for DAE. Based on the SUCRA, secukinumab-low dose (SEC-L) ranked first in the achieved PASI 90 response (84.7 %), followed by ixekizumab (70.8 %).Among all biologic treatments, SEC-L showed the best PASI 90 response without increasing the risk for DAE. More long-term studies are warranted.

ObjectivesTo compare cognitive effects and acceptability of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in patients with Alzheimer’s disease (AD) or mild cognitive impairment (MCI), and to determine whether cognitive training (CT) during rTMS or tDCS provides additional benefits.MethodsElectronic search of PubMed, Medline, Embase, the Cochrane Library and PsycINFO up to 5 March 2020. We enrolled double-blind, randomised controlled trials (RCTs). The primary outcomes were acceptability and pre–post treatment changes in general cognition measured by Mini-Mental State Examination, and the secondary outcomes were memory function, verbal fluency, working memory and executive function. Durability of cognitive benefits (1, 2 and ≥3 months) after brain stimulation was examined.ResultsWe included 27 RCTs (n=1070), and the treatment components included high-frequency rTMS (HFrTMS) and low-frequency rTMS, anodal tDCS (atDCS) and cathodal tDCS (ctDCS), CT, sham CT and sham brain stimulation. Risk of bias of evidence in each domain was low (range: 0%–11.1%). HFrTMS (1.08, 9, 0.35–1.80) and atDCS (0.56, 0.03–1.09) had short-term positive effects on general cognition. CT might be associated with negative effects on general cognition (−0.79, –2.06 to 0.48) during rTMS or tDCS. At 1-month follow-up, HFrTMS (1.65, 0.77–2.54) and ctDCS (2.57, 0.20–4.95) exhibited larger therapeutic responses. Separate analysis of populations with pure AD and MCI revealed positive effects only in individuals with AD. rTMS and tDCS were well tolerated.ConclusionsHFrTMS is more effective than atDCS for improving global cognition, and patients with AD may have better responses to rTMS and tDCS than MCI.

Background Previous studies have suggested that biologic therapy for psoriasis might relate to body weight gain. Objective To assess the changes in body weight and body mass index (BMI) in psoriasis patients after receiving various biologics. Methods We conducted a systematic review and network meta-analysis to evaluate the changes in body weight and BMI in psoriasis patients receiving biologics. On March 1, 2019, we searched Medline, Embase, and Cochrane Central Register of Controlled Trials for relevant studies. The Newcastle-Ottawa scale was used to assess the risk of bias. Results We included 6 studies with 862 psoriasis patients. Compared with conventional systemic treatments, treatment with tumor necrosis factor α inhibitors was associated with a significant increase in body weight (mean difference 1.40 kg, 95% confidence interval 0.88-1.93 kg) and BMI (0.39 kg/m2, 95% confidence interval 0.24-0.54 kg/m2). In contrast, no significant increase in body weight or BMI was found among patients receiving anti-interleukin (IL)-12/23 or anti-IL-17 biologics. Limitations Only 1 study reported body weight and BMI for patients receiving the anti-IL-17 biologic. Conclusion Tumor necrosis factor α inhibitor treatment appears to be associated with an increase in body weight and BMI, and treatment with anti-IL-12/23 and anti-IL-17 biologics do not. This association should be considered before initiating biologics for overweight and obese patients.