{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:41:14Z","timestamp":1792075274570,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Scalp psoriasis is a recalcitrant phenotype that imposes a substantial burden on quality of life. While the therapeutic landscape has expanded, comprehensive comparative evidence for newer biologics and small molecules in this specific manifestation remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To systematically compare the short\u2010term efficacy, safety and tolerability of biologics and small molecules for scalp psoriasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and network meta\u2010analysis (NMA) of randomized controlled trials (RCTs) identified from MEDLINE, EMBASE, CENTRAL and other databases from inception to October 2025. The primary efficacy endpoint was scalp clearance (defined as Scalp Physician's Global Assessment [scPGA] 0\/1, scalp\u2010specific Investigator's Global Assessment [ss\u2010IGA] 0\/1 or Psoriasis Scalp Severity Index [PSSI] 90\/100) at Weeks 12\u201316. Safety outcomes included all\u2010grade adverse events (AEs) and serious AEs (SAEs). Tolerability was defined as the discontinuation rate due to AEs. Data were synthesized using a frequentist random\u2010effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen RCTs comprising 10,266 patients were included. All active agents demonstrated statistically significant improvements versus placebo. Ixekizumab every 2\u2009weeks (Q2W) (odds ratio [OR] 54.02; 95% confidence interval [CI] 39.38\u201374.09) and brodalumab (OR 53.16; 95% CI 15.47\u2013182.69) ranked highest for scalp clearance, followed by ixekizumab every 4\u2009weeks (Q4W), guselkumab and bimekizumab. Regarding safety, secukinumab, tildrakizumab, apremilast, deucravacitinib and both ixekizumab regimens were associated with significantly higher incidences of all\u2010grade AEs compared with placebo, whereas SAE risks were non\u2010significant across interventions. Apremilast was the only agent associated with significantly higher discontinuation rates due to AEs (OR 1.62; 95% CI 1.09\u20132.42).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Interleukin\u201017 inhibitors, particularly ixekizumab and brodalumab, demonstrated the most significant short\u2010term scalp clearance. Guselkumab showed a favourable balance of efficacy, safety and tolerability. Serious adverse events were not significantly increased with any agent. Collectively, these findings provide up\u2010to\u2010date comparative evidence to inform the selection of systemic therapies for scalp psoriasis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdv.70506","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T04:20:46Z","timestamp":1778905246000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Systematic review and network meta\u2010analysis of biologics and small molecules for scalp psoriasis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8335-1617","authenticated-orcid":false,"given":"I\u2010Chang","family":"Lai","sequence":"first","affiliation":[{"name":"Department of Education China Medical University Hospital, China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuan\u2010Chun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Acupuncture, Department of Chinese Medicine China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guan\u2010Lun","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Public Health, Faculty of Medicine Imperial College London  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Yuan","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine China Medical University  Taichung Taiwan"},{"name":"Department of Dermatology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41572-025-00630-5","article-title":"Psoriasis","volume":"11","author":"Armstrong AW","year":"2025","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/bjd.17689","article-title":"Localization of treatment\u2010resistant areas in patients with psoriasis on biologics","volume":"181","author":"Hjuler KF","year":"2019","journal-title":"Br J Dermatol"},{"issue":"3","key":"e_1_2_12_4_1","first-page":"425","article-title":"Hard\u2010to\u2010treat areas in psoriasis: an Underevaluated part of the disease","volume":"15","author":"Lupulescu AM","year":"2025","journal-title":"Life 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