Comparison of short-term adverse reactions of small molecule inhibitors and biologics in the treatment of palmoplantar psoriasis and palmoplantar pustulosis: A systematic review and network Meta-analysis.

Abstract

Palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) are inflammatory disorders of the palms and soles that are challenging to manage clinically. We searched Embase, PubMed, Web of Science, and the Cochrane Library on February 28, 2026 for eligible randomized controlled trials involving adults with PP or PPP. Primary outcomes were any adverse events (AEs), serious AEs, and infections; secondary outcomes were other AEs. Risk of bias was assessed using Cochrane RoB 2.0, and network meta-analysis was conducted using R 4.5.1 and StataSE 15.1. A total of 24 studies involving 2655 participants were included. In the pooled analysis of PP and PPP, guselkumab 100 mg had a lower risk of any AEs (surface under the cumulative ranking curve, SUCRA: 79.22%), whereas adalimumab 40 mg ranked more favorably for serious AEs (SUCRA: 82.20%) and infections (SUCRA: 66.61%). Stratified analyses showed that in PP, adalimumab 40 mg had a lower risk of any AEs (SUCRA: 73.93%) and infections (SUCRA: 79.16%), whereas risankizumab 150 mg had a lower risk of serious AEs (SUCRA: 91.10%). In PPP, guselkumab 100 mg had a lower risk of any AEs (SUCRA: 85.46%) and infections (SUCRA: 81.62%), whereas brodalumab 210 mg had a lower risk of serious AEs (SUCRA: 68.40%). Based on currently available short-term RCT evidence, guselkumab 100 mg had a lower risk of any AEs whereas adalimumab 40 mg ranked more favorably for serious AEs and infections. Given short follow-up durations, few relevant events, and wide credible intervals, all comparative findings should be interpreted with caution.