A meta-analysis in JAMA Dermatology has demonstrated several clinical features associated with poorer response to biologics in patients with psoriasis.
The research team from the University of Copenhagen and Copenhagen University Hospital in Denmark ultimately included 40 studies with a total of 21,438 patients in their analysis.
The following study excerpts have been edited for length and clarity.
What was the authors’ intention?
Researchers systematically investigated the relationship between certain clinical characteristics and the effectiveness of biologics in patients with psoriasis.
What were the main findings of this meta-analysis?
Observational studies have shown that several factors were negatively correlated with achieving a score of 90 on the Psoriasis Area and Severity Index (PASI) scale at 6 months: older age (OR 0.99; 95% CI 0.98–1.00), previous exposure to biologics (OR 0.44; 95% CI 0.29–0.67), higher BMI (OR 0.96; 95% CI 0.94–0.99), previous smoking (OR 0.81; 95% CI 0.67–0.98), and current smoking (OR 0.78; 95% CI 0.66–0.91).
In randomized clinical trials included in the meta-analysis, only a BMI of 30 or higher was negatively associated with treatment response (PASI 90 at 3 months: OR 0.57; 95% CI 0.48-0.66). Overall, the researchers identified prior exposure to biologics as the characteristic with the greatest negative influence on subsequent biologic response.
The researchers found no evidence that gender, diabetes, psoriatic arthritis and several other clinical characteristics were associated with response to treatment.
The meta-analysis found “low-certainty evidence of a negative association between smoking and biologic treatment in the observational studies.” Although high-certainty evidence is lacking, the authors concluded that it is “conceivable to hypothesize that psoriasis severity might improve with smoking cessation.”
What insights can dermatologists gain from this study?
There are several reasons for switching biologics, including primary and secondary treatment failure, side effects, participation in clinical trials, and cost. These reasons are rarely reported and may affect outcomes.
For example, there is evidence that patients with secondary biological failure are more likely to experience a response when switching treatment than patients with primary failure.
In addition, dose adjustment can sometimes improve efficacy in patients who experience loss of efficacy. Therefore, distinguishing between primary and secondary failures could serve as an important confounding variable.
Co-authors reported relationships with AbbVie, Almirall, BMS, Boehringer Ingelheim, Bristol-Myers Squibb, Galderma, Janssen, Eli Lilly, LEO Pharma, Novartis, Pfizer, Sandoz, Sanofi, and UCB.
