Several factors linked with multiple biologic failure in patients with psoriasis

Key takeaways:

• Female sex at birth was associated with multiple biologic failure in patients with psoriasis.
• Identifying factors associated with failure may indicate who needs frequent follow-up.

Factors associated with multiple biologic failure in patients with psoriasis may indicate who would benefit from frequent follow-up, according to a study.

A prospective cohort analysis found that of 1,039 patients with psoriasis, 6.3% experienced multiple biologic failure (MBF), defined in this study as patients who were administered two or more biologic agents of different mechanistic classes and discontinued the biologics due to “physician-reported ‘inadequate initial response,’ ‘failure to maintain initial response’ or ‘active disease’” despite using each biologic for 90 days or more.

According to Joy Q. Jin, of the University of California at San Francisco, and colleagues, “These ‘multiple biologic failure’ patients are not well-characterized, and the patterns of biologics attempted and sociodemographic or clinical features that may predict difficult treatment are incompletely studied.”

In multivariable modeling, the factors significantly associated with MBF included female sex at birth (OR = 2.29; 95% CI, 1.11-4.72), psoriasis duration (OR = 0.60 per SD; 95% CI, 0.38-0.94), year of index biologic initiation (OR = 0.37 per year; 95% CI, 0.27-0.52), prior non-biologic systemic therapy use (OR = 2.47; 95% CI, 1.16-5.25), history of hyperlipidemia (OR = 3.14; 95% CI, 1.35-7.30) and Medicaid insurance (OR = 4.53; 95% CI, 1.40-14.60). However, hyperlipidemia history and Medicaid insurance had wide confidence intervals, which the authors said indicated a lower level of support.

In a univariable logistic regression, health-related factors such as smoking, alcohol use and BMI and the morphology/extent of psoriasis were not associated with MBF.

“These insights may help risk-stratify psoriasis patients predisposed to higher rates of biologic switching or poor efficacy, identifying patients who may benefit from more frequent follow-up,” the authors wrote.