Comparison 1.

Primary outcome ‐ PASI 90

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Conventional systemic agents versus placebo	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
1.1 Methotrexate	2	282	Risk Ratio (M‐H, Random, 95% CI)	2.60 [0.26, 25.90]
1.2 Fumaric acid esters	1	704	Risk Ratio (M‐H, Random, 95% CI)	4.47 [2.01, 9.95]
2 Conventional systemic 1 versus conventional systemic 2	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
2.1 Ciclosporin versus methotrexate	2	172	Risk Ratio (M‐H, Random, 95% CI)	1.18 [0.47, 2.98]
2.2 Methotrexate versus fumaric acid esters	1	60	Risk Ratio (M‐H, Random, 95% CI)	2.0 [0.19, 20.90]
3 Anti‐TNF alpha versus placebo	21		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
3.1 Etanercept versus placebo	12	4954	Risk Ratio (M‐H, Random, 95% CI)	11.17 [7.66, 16.28]
3.2 Adalimumab versus placebo	8	3199	Risk Ratio (M‐H, Random, 95% CI)	14.86 [8.93, 24.73]
3.3 Certolizumab versus placebo	1	176	Risk Ratio (M‐H, Random, 95% CI)	24.58 [3.48, 173.49]
4 Ustekinumab versus placebo	7	3832	Risk Ratio (M‐H, Random, 95% CI)	22.59 [14.74, 34.64]
5 Anti‐IL17 versus placebo	16		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
5.1 Secukinumab versus placebo	7	2707	Risk Ratio (M‐H, Random, 95% CI)	26.52 [14.91, 47.17]
5.2 Ixekizumab versus placebo	4	3268	Risk Ratio (M‐H, Random, 95% CI)	53.85 [15.34, 189.07]
5.3 Brodalumab versus placebo	5	4109	Risk Ratio (M‐H, Random, 95% CI)	26.33 [16.77, 41.33]
6 Anti‐IL23 versus placebo	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
6.1 Guselkumab versus placebo	3	1502	Risk Ratio (M‐H, Random, 95% CI)	24.87 [14.20, 43.55]
6.2 Tildrakizumab versus placebo	1	355	Risk Ratio (M‐H, Random, 95% CI)	15.63 [2.24, 109.29]
7 Other biologics	1	225	Risk Ratio (M‐H, Random, 95% CI)	12.26 [0.76, 197.54]
7.1 Itolizumab versus placebo	1	225	Risk Ratio (M‐H, Random, 95% CI)	12.26 [0.76, 197.54]
8 Biologic versus conventional systemic treatments	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
8.1 Etanercept versus acitretin	1	60	Risk Ratio (M‐H, Random, 95% CI)	11.00 [0.64, 190.53]
8.2 Infliximab versus methotrexate	1	868	Risk Ratio (M‐H, Random, 95% CI)	2.86 [2.15, 3.80]
8.3 Adalimumab versus methotrexate	1	218	Risk Ratio (M‐H, Random, 95% CI)	3.73 [2.25, 6.19]
8.4 Alefacept versus methotrexate	1	212	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.42, 2.98]
9 Biologic 1 versus biologic 2	10		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
9.1 Ustekinumab versus Etanercept	1	903	Risk Ratio (M‐H, Random, 95% CI)	1.80 [1.45, 2.24]
9.2 Secukinumab versus etanercept	1	980	Risk Ratio (M‐H, Random, 95% CI)	2.32 [1.85, 2.92]
9.3 Ixekizumab versus etanercept	2	2209	Risk Ratio (M‐H, Random, 95% CI)	2.98 [2.24, 3.98]
9.4 Secukinumab versus ustekinumab	1	676	Risk Ratio (M‐H, Random, 95% CI)	1.38 [1.23, 1.53]
9.5 Brodalumab versus ustekinumab	2	3088	Risk Ratio (M‐H, Random, 95% CI)	1.27 [1.16, 1.39]
9.6 Guselkumab versus adalimumab	3	1658	Risk Ratio (M‐H, Random, 95% CI)	1.41 [1.25, 1.60]
10 Small molecules versus placebo	9		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
10.1 Apremilast versus placebo	4	1775	Risk Ratio (M‐H, Random, 95% CI)	6.78 [3.03, 15.17]
10.2 Tofacitinib versus placebo	4	2826	Risk Ratio (M‐H, Random, 95% CI)	6.80 [3.86, 11.99]
10.3 Ponesimod versus placebo	1	326	Risk Ratio (M‐H, Random, 95% CI)	6.60 [1.65, 26.41]
11 Biologic versus small molecules	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
11.1 Etanercept versus Tofacitinib	1	998	Risk Ratio (M‐H, Random, 95% CI)	1.13 [0.93, 1.38]
11.2 Etanercept versus apremilast	1	166	Risk Ratio (M‐H, Random, 95% CI)	1.42 [0.72, 2.78]