***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous studies of infliximab in psoriasis have demonstrated rapid improvement with induction therapy and sustained response with regularly administered maintenance therapy . OBJECTIVE The efficacy and safety of continuous ( every-8-week ) and intermittent ( as-needed ) maintenance regimens were compared . METHODS Patients with moderate-to-severe psoriasis ( n = 835 ) were r and omized to induction therapy ( weeks 0 , 2 , and 6 ) with infliximab 3 mg/kg or 5 mg/kg or placebo . Infliximab-treated patients were r and omized again at week 14 to continuous or intermittent maintenance regimens at their induction dose . RESULTS At week 10 , 75.5 % and 70.3 % of patients in the infliximab 5 mg/kg and 3 mg/kg groups , respectively , achieved PASI 75 ; 45.2 % and 37.1 % achieved PASI 90 ( vs 1.9 % [ PASI 75 ] and 0.5 % [ PASI 90 ] for placebo ; P < .001 ) . Through week 50 , PASI responses were better maintained with continuous compared with intermittent therapy within each dose , and with 5 mg/kg compared with 3 mg/kg continuous therapy . LIMITATIONS Longer term ( > 1 year ) maintenance therapy and further study of  infliximab serum concentrations over this period , in both PASI 75 responders and non-responders , would be preferable . CONCLUSIONS Through week 50 , response was best maintained with continuous infliximab therapy . Infliximab was generally well-tolerated in most patients Background Apremilast , an oral , small‐molecule phosphodiesterase 4 inhibitor , has demonstrated efficacy in patients with moderate‐to‐severe psoriasis . Objective Evaluate efficacy and safety of apremilast vs. placebo in biologic‐naive patients with moderate‐to‐severe plaque psoriasis and safety of switching from etanercept to apremilast in a phase IIIb , r and omized , double‐blind , placebo‐controlled study ( NCT01690299 ) . Methods Two hundred and fifty patients were r and omized to placebo ( n = 84 ) , apremilast 30 mg BID ( n = 83 ) or etanercept 50 mg QW ( n = 83 ) through Week 16 ; thereafter , all patients continued or switched to apremilast through Week 104 . The primary efficacy endpoint was achievement of PASI‐75 at Week 16 with apremilast vs. placebo . Secondary endpoints included achievement of PASI‐75 at Week 16 with etanercept vs. placebo and improvements in other clinical endpoints vs. placebo at Week 16 . Outcomes were assessed through Week 52 . This study was not design ed for apremilast vs. etanercept comparisons . Results At Week 16 , PASI‐75 achievement was greater with apremilast ( 39.8 % ) vs. placebo ( 11.9 % ; P < 0.0001 ) ; 48.2 % of patients achieved PASI‐75  with etanercept ( P < 0.0001 vs. placebo ) . PASI‐75 response was maintained in 47.3 % ( apremilast/apremilast ) , 49.4 % ( etanercept/apremilast ) and 47.9 % ( placebo/apremilast ) of patients at Week 52 . Most common adverse events ( ≥5 % ) with apremilast , including nausea , diarrhoea , upper respiratory tract infection , nasopharyngitis , tension headache and headache , were mild or moderate in severity ; diarrhoea and nausea generally resolved in the first month . No new safety or tolerability issues were observed through Week 52 with apremilast . Conclusion Apremilast demonstrated significant efficacy vs. placebo at Week 16 in biologic‐naive patients with psoriasis , which was sustained over 52 weeks , and demonstrated safety consistent with the known safety profile of apremilast . Switching from etanercept to apremilast did not result in any new or clinical ly significant safety findings , and efficacy was maintained with apremilast through Week 52 The interleukin‐17 cytokine family plays a central role in psoriasis pathogenesis Background User satisfaction is an important factor associated with treatment adherence in chronic diseases including moderate‐to‐severe psoriasis . Objective To evaluate the efficacy , safety and patient acceptability of 300 and 150 mg secukinumab – a fully human anti‐interleukin‐17A monoclonal antibody that has demonstrated efficacy in the treatment of patients with moderate‐to‐severe plaque psoriasis – self‐administered by autoinjection . Methods Patients with moderate‐to‐severe plaque psoriasis were r and omized to secukinumab 300 mg , secukinumab 150 mg or placebo self‐administered by autoinjection at baseline , Weeks 1 , 2 and 3 and then every 4 weeks from Week 4 to Week 48 . Efficacy responses [ ≥75/90/100 % improvement in Psoriasis Area and Severity Index ( PASI 75/90/100 ) and clear/almost clear skin by Investigator 's Global Assessment 2011 modified version ( IGA mod 2011 0/1 ) ] were measured at Week 52 . Patient‐reported usability of the autoinjector was evaluated by the self‐injection assessment question naire to Week 48 . Results At Week 52 with secukinumab 300 mg , PASI 75/90/100 and IGA mod 2011 0/1 responses were achieved by 81.4/64.1/38.8 % and 69.6 % of patients , respectively , by multiple imputation . At Week 52 with secukinumab 150 mg , PASI 75/90/100 and IGA mod 2011 0/1 responses were achieved by 75.2/57.4/33.1 % and 60.2 % of patients , respectively , by multiple imputation . Patient‐assessed acceptability of the autoinjector remained high to Week 48 . The proportion of patients experiencing adverse events was greater with secukinumab 300 mg ( 88.6 % ) than with secukinumab 150 mg ( 78.7 % ) . Conclusion Self‐administration of secukinumab using an autoinjector was associated with robust and sustained efficacy , a good safety profile and high acceptability WHAT IS KNOWN AND OBJECTIVE Psoriasis is a chronic skin disease for which there is an increasing range of treatment options . Biological agents ( ustekinumab , adalimumab , infliximab and etanercept ) are indicated for moderate-to-severe plaque-type psoriasis in adults who fail to respond to , have a contraindication to , or are intolerant to other systemic therapies including cyclosporine , methotrexate and PUVA  Unfortunately , with new drugs , the pivotal trials leading to their licensing are often placebo-controlled trials rather than comparative trials vs. established therapies . Therefore , inference on comparative effectiveness of the newer agents must be derived indirectly , through estimation of effects of the new agents vs. a common comparator . The objective of this study is to compare the relative efficacy of the biological agents through a systematic review of the indirect clinical trial evidence . METHODS A systematic literature search was performed for clinical trials of biological agents in psoriasis . Pivotal , r and omized , double-blind , controlled ( placebo )  trials using intention-to-treat analysis were selected for detailed analysis . Trials must include PASI 75 as a primary end point . The indirect comparison was performed using the method of Bucher adjusted with the ITC calculator ( Indirect Treatment Comparisons of the Canadian Agency for Drugs and Technologies in Health ) , etanercept being the reference drug . We defined delta value for therapeutic equivalence as a difference in the efficacy of 25 % among the different treatment options . RESULTS AND DISCUSSION Fourteen studies ( four for ustekinumab , three for adalimumab , three for infliximab and four for etanercept ) were included . The indirect comparison results reveal that ustekinumab , adalimumab and infliximab were statistically superior to etanercept with an absolute risk difference for PASI 75 of 12 % ( 95 % CI = 5·9 - 18 % ) , 11 % ( 95 % CI = 5·3 - 16·7 % ) and 24 % ( 29·7 - 18·3 % ) respectively . However , in all situations , the 95 % confidence interval does not achieve clinical relevance as no delta exceeds the previously set value ( 25 % ) . WHAT IS NEW AND CONCLUSION Ustekinumab , adalimumab , infliximab and etanercept can be regarded as clinical equivalents for the treatment of psoriasis . Choice between these agents therefore depends on their relative safety profiles , individual contra-indications and cost effectiveness BACKGROUND Tumour necrosis factor alpha ( TNFalpha ) is thought to play a part in the pathogenesis of psoriasis . We assessed the efficacy and safety of continuous treatment with infliximab , a monoclonal antibody that binds to and neutralises the activity of TNFalpha , in patients with psoriasis . METHODS In this phase III , multicentre , double-blind trial , 378 patients with moderate-to-severe plaque psoriasis were allocated in a 4:1 ratio to receive infusions of either infliximab 5 mg/kg or placebo at weeks 0 , 2 , and 6 , then every 8 weeks to week 46 . At week 24 , placebo-treated patients crossed over to infliximab treatment .  Skin and nail signs of psoriasis were assessed using the psoriasis area and severity index ( PASI ) and nail psoriasis severity index ( NAPSI ) , respectively . The primary endpoint , analysed on an intention-to-treat-basis , was the proportion of patients achieving at least a 75 % improvement in PASI from baseline to week 10 . FINDINGS At week 10 , 80 % ( 242/301 ) of patients treated with infliximab achieved at least a 75 % improvement from their baseline PASI ( PASI 75 ) and 57 % ( 172/301 ) achieved at least a 90 % improvement ( PASI 90 ) , compared with 3 % and 1 % in the placebo group , respectively ( p<0.0001 ) . At week 24 , PASI 75 ( 82 % for infliximab vs 4 % for placebo ) and PASI 90 ( 58%vs 1 % ) were maintained ( p<0.0001 ) . At week 50 , 61 % achieved PASI 75 and 45 % achieved PASI 90 in the infliximab group . Infliximab was generally well tolerated in most patients . INTERPRETATION Infliximab is effective in both an induction and maintenance regimen for the treatment of moderate-to-severe psoriasis , with a high percentage of patients achieving sustained PASI 75 and PASI 90 improvement through 1 year BACKGROUND Little is known about the effect of specific anti-interleukin-23 therapy , as compared with established anti-tumor necrosis factor therapies , for the treatment of moderate-to-severe plaque psoriasis . METHODS In a 52-week , phase 2 , dose-ranging , r and omized , double-blind , placebo-controlled , active-comparator trial , we compared guselkumab ( CNTO 1959 ) , an anti-interleukin-23 monoclonal antibody , with adalimumab in patients with moderate-to-severe plaque psoriasis . A total of 293 patients were r and omly assigned to receive guselkumab ( 5 mg at weeks 0 and 4 and every 12 weeks thereafter , 15 mg every 8 weeks , 50 mg at weeks 0 and 4 and every 12 weeks thereafter , 100 mg every 8 weeks , or 200 mg at weeks 0 and 4 and every 12 weeks thereafter ) through week 40 , placebo , or adalimumab ( st and ard dosage for psoriasis ) . At week 16 , patients in the placebo group crossed over to receive guselkumab at a dose of 100 mg every 8 weeks . The primary end point was the proportion of patients with a Physician 's Global Assessment ( PGA ) score of 0 ( indicating cleared psoriasis ) or 1 ( indicating minimal psoriasis ) at week 16 . RESULTS At week 16 , the proportion of patients with a PGA score of 0 or 1 was significantly higher in each guselkumab group than in the placebo group : 34 % in the 5-mg group , 61 % in the 15-mg group , 79 % in the 50-mg group , 86 % in the 100-mg group , and 83 % in the 200-mg group , as compared with 7 % in the placebo group ( P≤0.002 for all comparisons ) . Moreover , the proportion was significantly higher in 
    Output:
    
Four 52-week r and omized controlled trials ( RCTs ) comprised the primary analysis , which found brodalumab was significantly more efficacious than secukinumab , ustekinumab and etanercept .
Secukinumab was also more efficacious than ustekinumab and both outperformed etanercept .
Results were consistent with the primary analysis : brodalumab was most effective , followed by ixekizumab and secukinumab , then ustekinumab , infliximab and adalimumab .
Etanercept and apremilast had the lowest expected long-term efficacy .
Results were similar when studies with low prior exposure to biological therapies were excluded .
Results suggest that brodalumab is associated with a higher likelihood of sustained PASI response , including complete clearance , at week 52 than comparators .