Characterization and treatment outcomes of biologic therapy in super-responders and biologic-refractory psoriasis patients: A single-center retrospective study in China

Abstract

Background

Despite advances in the availability of effective biologics in psoriasis over the past decade, clinical characteristics, persistence, and safety associated with treatment response have never been systematically investigated.

Objectives

The objective of this study was to evaluate the factors, persistence, and safety associated with super-response (super-responder, SR) or refractory (biologic-refractory patient, BRP) to biologic agents.

Methods

This retrospective analysis included psoriasis patients who initiated their first biologic therapy. Multivariable logistic regression analysis identified predictors for SRs and BRPs. Drug survival used Kaplan-Meier plot analysis.

Results

Seven hundred thirty-seven patients were included (140 SRs [19.0%], 34 BRPs [4.6%]). Body mass index <25, lower Charlson Comorbidity Index, without psoriatic arthritis, with a family history of psoriasis, and lower insulin resistance level were significantly associated with SRs, whereas body mass index ≥30, with nonalcoholic fatty liver disease, higher psoriasis area and severity index, and higher erythrocyte sedimentation rate level were independent predictors of BRPs. SRs were associated with treatment persistence of biologics, but BRPs were linked with poor persistence and higher incidences of adverse events—particularly paradoxical eczema.

Limitations

Single-center study with limited patients.

Conclusion

Our study identified predictors of response that may facilitate accurate drug targeting with good persistence and reassuring safety for psoriasis patients.