A meta-analysis in has demonstrated several clinical characteristics that are associated with a poorer response to biologics in patients with psoriasis.
The research team at the University of Copenhagen and Copenhagen University Hospital in Denmark ultimately included 40 studies in their analysis, encompassing a total of 21,438 patients.
The following study excerpts have been edited for length and clarity.
What was the authors' intent?
Researchers systematically evaluated the association between certain clinical characteristics and the effectiveness of biologics in patients with psoriasis.
What were the key findings of this meta-analysis?
Observational studies revealed that several factors were negatively associated with achieving a score of 90 on the Psoriasis Area and Severity Index (PASI) scale at the 6-month mark: 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 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, researchers identified previous exposure to biologics as the characteristic with the biggest negative impact on subsequent biologic response.
Researchers found no evidence that sex, diabetes, psoriatic arthritis, and several other clinical characteristics were associated with treatment response.
The meta-analysis found "low-certainty evidence of a negative association between smoking and biologic treatment in the observational studies." Still, although there is a shortage of high-certainty evidence, authors concluded that it is "conceivable to hypothesize that the severity of psoriasis may improve on smoking cessation."
What can dermatologists take away from this study?
There are diverse reasons for switching biologics, which include primary and secondary treatment failures, adverse events, participation in clinical trials, and cost. These reasons are rarely reported and could affect the outcomes.
For example, evidence has shown that patients who experience secondary biologic failure are more likely to achieve a response when they switch treatments, as opposed to those who experience primary failure.
In addition, dose adjustment can sometimes improve response in patients who experience loss of response. Hence, the differentiation between primary and secondary failures could serve as an essential 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.
Primary Source
JAMA Dermatology
Source Reference: