Efficacy and safety of biologics in erythrodermic psoriasis: a systematic review and single-arm meta-analysis

Abstract

Introduction: Erythrodermic psoriasis (EP) is a rare but severe inflammatory skin disease that affects the whole body. It presents clinically as widespread redness, scaling, and systemic symptoms. Treatment choices are currently limited, and conventional drugs often raise safety issues, highlighting the need for more effective and safer treatments. Biologics have emerged as a new approach. This study aimed to systematically evaluate the efficacy and safety of different biologics for EP by conducting a systematic review and single-arm meta-analysis.

Methods: We performed a systematic search of four databases-Embase, PubMed, Scopus, and the Cochrane Library-for relevant clinical studies published up to May 2025. Treatment effects were evaluated by analyzing statistical data such as single-arm PASI 75 response rates and their 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and subgroup analyses were conducted based on drug targets and treatment duration. A random-effects meta-analysis was applied to quantitatively synthesize the data. All statistical analyses were performed using Stata 18.0 software.

Results: A total of 18 studies involving 342 patients were included in the analysis. Patients receiving IL-17-targeted biologics achieved higher PASI 75 response rates compared to those treated with TNF-α or IL-23-targeted biologics. Response rates for IL-17-targeted agents continued to climb over 12 weeks, peaking at 82% by week 16, indicating superior efficacy in improving skin lesions compared to other biologic categories. IL-23-targeted biologics exhibited the lowest incidence of adverse events (5%, 95% confidence interval: 4%-13%), suggesting superior safety compared to IL-17 and TNF-α-targeted therapies.

Discussion: This single-arm meta-analysis demonstrates the efficacy and safety of biologics in treating erythrodermic psoriasis (EP). These treatments are particularly valuable for rapid control and long-term management of the disease. Further large-scale studies with long-term follow-up are needed to confirm their benefits in specific patient groups and for preventing recurrence.

Keywords: PASI 75; biologics; efficacy; erythrodermic psoriasis; safety.