Certain factors may limit biologic treatment effectiveness in psoriasis

Among patients with psoriasis, those who smoke or did previously, have been exposed to biologics, at older age, or with higher BMI appear to have poorer response to treatment with biologics, as reported in a meta-analysis.

Researchers performed a systematic review of studies in which response to biologic treatment at approved doses in patients with psoriasis in relation to their clinical characteristics was evaluated. They searched multiple online databases for relevant studies, such as observational studies and randomized clinical trials (RCTs) with outcomes of Psoriasis Area and Severity Index (PASI) 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment.

Of the 107 studies identified, 40 were included in the meta-analysis. The total study population comprised 21,438 patients. The primary outcome was PASI 90 at 26 weeks (6 months).

Data from observational studies, pooled using random-effects models, showed that several factors were negatively associated with achieving PASI 90 at 6 months. These factors were older age (odds ratio [OR], 0.99, 95 percent confidence interval [CI], 0.98–1.00), previous exposure to biologics (OR, 0.44, 95 percent CI, 0.29–0.67), higher BMI (OR, 0.96, 95 percent CI, 0.94–0.99), previous smoking (OR, 0.81, 95 percent CI, 0.67–0.98), and current smoking (OR, 0.78, 95 percent CI, 0.66–0.91).

On the other hand, pooled data from RCTs showed that BMI of ≥30 kg/m² was the sole factor that was negatively associated with treatment response (PASI 90 at 3 months: OR, 0.57, 95 percent CI, 0.48–0.66).

However, the impact of these clinical characteristics on treatment response remains to be elucidated across the various biologics used for psoriasis.