Comparative efficacy and safety of picankibart versus guselkumab and tildrakizumab for moderate-to-severe plaque psoriasis: a systematic review and individual participant data-anchored population-adjusted network meta-analysis

Background: Direct head-to-head evidence comparing picankibart, a recently approved interleukin-23 (IL-23) p19 inhibitor in China, with established class alternatives for moderate-to-severe plaque psoriasis is lacking. Conventional aggregate-data indirect comparisons may be biased by cross-trial differences in baseline characteristics. This study compared the short-term efficacy and safety of picankibart, guselkumab, and tildrakizumab using an individual participant data (IPD)-anchored, population-adjusted approach.

Methods: We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang from database inception to May 28, 2026. Eligible studies were phase III placebo-controlled randomized controlled trials (RCTs) evaluating induction-phase efficacy and safety of approved doses of picankibart, guselkumab, or tildrakizumab in adults with moderate-to-severe plaque psoriasis. IPD from the picankibart phase III trial were combined with aggregate comparator data using multilevel network meta-regression (ML-NMR). A Bayesian fixed-effect ML-NMR model adjusted for two prespecified baseline covariates: body mass index (BMI) and prior biologic exposure.

Results: Eight RCTs involving 3,099 randomized patients were included, including 401 receiving picankibart, 950 receiving guselkumab, 726 receiving tildrakizumab, and 1,022 receiving placebo; seven trials were judged to have low overall risk of bias and one had some concerns. In population-adjusted indirect comparisons (PAICs), picankibart demonstrated superior Psoriasis Area and Severity Index (PASI) 90 response compared with tildrakizumab [risk ratio (RR) 1.97, 95% credible interval (CrI): 1.24–3.15] and similar response to guselkumab (RR 1.02, 95% CrI: 0.70–1.38). Safety profiles were comparable across all active treatments; absolute risk differences (RDs) for any adverse event (AE) and serious adverse event (SAE) compared with placebo were small (≤1.2% and ≤0.4%, respectively) and showed no credible differences among interventions.

Conclusions: This PAIC suggests that picankibart provides superior induction-phase efficacy to tildrakizumab and similar efficacy to guselkumab, with a comparable short-term safety profile. These findings suggest that picankibart is a highly competitive addition to the therapeutic armamentarium for moderate-to-severe plaque psoriasis in China, although head-to-head trials are warranted to substantiate these indirect comparisons.