Smoking, Age, BMI, Previous Exposure Impact Response to Biologics for Psoriasis

Smoking, older age, higher BMI, and previous exposure to biologics were found to be negatively associated with experiencing a 90% reduction in Psoriasis Area and Severity Index (PASI) scores in patients with psoriasis treated with biologics, a meta-analysis published in JAMA Dermatology found.¹

In this study, the researchers aimed to evaluate the association between clinical characteristics and the effectiveness of biologics in treating psoriasis.

“To date and to our knowledge, no pooled analysis has examined the associations between clinical characteristics and the effectiveness of biologics in patients with psoriasis,” wrote the researchers of the study. “Therefore, we conducted a meta-analysis on this topic.”

Biologics have become an important treatment outcome for patients with moderate-to-severe psoriasis when other treatments have failed. FDA-approved drugs such as tildrakizumab (Ilyuma) work by blocking reactions in the body that drive psoriasis and its symptoms.²

In this study, the researchers aimed to evaluate the association between clinical characteristics and the effectiveness of biologics in treating psoriasis.¹

PubMed, Embase, and Web of Science were searched from their inception through April 2022 for studies that reported on responses to biologic treatment in patients with psoriasis in relation to their clinical characteristics. Only studies that reported PASI 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment were included, and the primary study outcome was PASI 90 at 26 weeks.

Sensitivity analyses were conducted, where the researchers repeated the primary outcome without the studies that only presented univariable results to generate more reliable estimates. Additionally, the researchers wanted to conduct subgroup analyses to determine the potential differences in the pooled estimates based on the different biologics. However, because there were not enough studies included in each meta-analyses, the researchers were unable to complete the analyses.

The database search resulted in a total of 2322 studies, however, after removing duplicates and screening, 23 studies were included, while an additional 17 studies were included through reference lists.

The 40 studies included a total of 21,438 patients. 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) were negatively associated with achieving PASI 90 at 6 months in observational studies.

In the included randomized controlled trials, 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).

However, the researchers acknowledged some limitations to the study, including comprehensive search strategy limitations, citation bias, possible exclusion of relevant studies, and inclusion of univariable and multivariable results. Additionally, because the subgroup analyses were not able to be conducted, the authors noted that further research is needed to evaluate the differential effects of the clinical characteristics by the various biologics.

Despite these limitations, the researchers believe the findings suggest that smoking, older age, higher BMI, and previous exposure to biologics were clinical characteristics associated with negative treatment outcomes in patients with psoriasis treated with biologics.

“Although we found no significant association between bioexperience and treatment response in the RCTs, our results from the observational studies indicate that bioexperience is the clinical characteristic with the most significant association with treatment response,” the researchers wrote. “Nonetheless, there are diverse reasons for switching biologics, which include primary and secondary treatment failures, adverse events, participation in clinical trials, and cost.”

References

1. Hjort G, Schwarz CW, Skov L, et al. Clinical characteristics associated with response to biologics in the treatment of psoriasis: A meta-analysis. JAMA Dermatol. Published online June 18, 2024. doi:10.1001/jamadermatol.2024.1677

2. Psoriasis treatment: Biologics. American Academy of Dermatology. Accessed July 24, 2024. https://www.aad.org/public/diseases/psoriasis/treatment/medications/biologics