Sociodemographic and Clinical Characteristics Associated With Multiple Biologic Failure in Patients With Psoriasis

TAKE-HOME MESSAGE

• This prospective cohort study of 1039 patients with psoriasis found that female sex, prior non-biologic systemic therapy use, shorter disease duration, earlier biologic initiation, hyperlipidemia, and Medicaid insurance were the factors associated with multiple biologic failure (MBF). Health-related behaviors and the extent of psoriasis were not significant predictors of MBF. Switching from a TNF-α inhibitor to an IL-17 inhibitor, an IL-12/23 inhibitor to an IL-17 inhibitor, and a TNF-α inhibitor to an IL-12/23 inhibitor were the most common first-to-second biologic sequences associated with MBF.
• This study highlights specific factors associated with poor therapeutic response to multiple biologic agents in patients with psoriasis, which may help to risk-stratify patients at a higher risk of biologic switching or treatment failure.

–  Lillian Sun, MD

BACKGROUND

Psoriasis patients with poor therapeutic response to multiple biologic agents are not well-characterized.

OBJECTIVE

To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic.

METHODS

This prospective cohort analysis evaluated patients in the multi-center CorEvitas Psoriasis Registry who initiated their first biologic between 2015-2020 and were followed for ≥24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued ≥2 biologics of different classes, each used for ≥90 days, due to inadequate efficacy) and GR (continued use of first biologic for ≥2 years) patients.

RESULTS

1,039 patients were analyzed (490 GR (47.2%), 65 MBF (6.3%)). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior non-biologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter two variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was TNF-α inhibitor to IL-17 inhibitor use.

LIMITATIONS

Biologic adherence between visits was not evaluated.

CONCLUSION

Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.

Journal of the American Academy of Dermatology

Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: a 2015-2022 prospective cohort analysis of the CorEvitas Psoriasis Registry

J Am Acad Dermatol 2023 Jul 24;[EPub Ahead of Print], JQ Jin, A Cronin, C Roberts-Toler, S Yeroushalmi, E Hadeler, RK Spencer, KG Elhage, G Gondo, EB Wallace, SM Reddy, G Han, J Kaffenberger, MS Davis, M Hakimi, JU Scher, AW Armstrong, T Bhutani, RR McLean, W Liao

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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