Personalized Medicine for Psoriasis: The Impact of Clinical Characteristics on Biologic Treatments

Original Article: Clinical Characteristics Associated With Response to Biologics in the Treatment of Psoriasis: A Meta-Analysis

What are the key takeaways of this article?

Psoriasis is a chronic inflammatory skin condition that significantly affects patients' quality of life. Traditional treatments have evolved with the advent of biologics, which target specific cytokines or receptors involved in the immunopathogenesis of psoriasis. These biologics include inhibitors of tumor necrosis factor (TNF)–α, interleukin (IL)-12/23, IL-17, and IL-23. While biologics have proven effective for many patients, some do not achieve the desired response, often leading to a switch to another biologic.

Research indicates that certain clinical characteristics, such as previous exposure to biologics (bioexperience), smoking, and high body mass index (BMI), can negatively affect the effectiveness of biologics. However, findings are inconsistent, given that some studies have not observed these associations. The impact of other clinical factors, like sex, on biologic efficacy remains uncertain, as does the variability of these effects across different biologic treatments. Understanding these associations could enable personalized treatment approaches.

As such, Hjort et al. conducted a meta-analysis by systematically evaluating the relationship between patient clinical characteristics and the effectiveness of biologics in treating psoriasis. Eligible studies reported associations between clinical characteristics and reductions in the Psoriasis Area and Severity Index of 75% (PASI 75) or 90% (PASI 90) at 12, 26, or 52 weeks (within a 4-week margin) in patients treated with approved dosing regimens of biologics. The primary outcome measure was PASI 90 at 26 weeks (6 months), with PASI 75 and PASI 90 at other time points as secondary outcomes.

The study's main findings revealed several important associations between clinical characteristics and the effectiveness of biologics in treating psoriasis:

1. Bioexperience: In observational studies, a pooled estimate from eight included studies demonstrated strong evidence of a negative association between previous biologic exposure (bioexperience) and achieving a 90% reduction in the Psoriasis Area and Severity Index (PASI 90) at 6 months (OR, 0.44; 95% CI, 0.29-0.67). However, no significant association was found in randomized controlled trials (RCTs).

2. BMI: Moderate to strong evidence from observational studies indicated that each 1-unit increase in BMI was associated with a reduced treatment response. While observational studies did not find a significant association between a BMI of 30 or higher and treatment response, RCTs showed that a BMI of 30 or higher had a negative impact on treatment response.

3. Smoking: Moderate evidence suggested that both current and past smoking negatively affected the attainment of PASI 90 at 6 months in observational studies, with low heterogeneity between studies.

4. Age: Low evidence from observational studies indicated a negative association between older age and treatment outcomes.

Overall, this meta-analysis found that previous exposure to biologics, higher BMI, smoking, and older age are clinical characteristics negatively associated with treatment outcomes in patients with psoriasis treated with biologics in observational studies. There is a need for further research to determine whether these effects vary by biologic therapy. Future studies could help clinicians tailor treatments based on individual patient characteristics, potentially improving outcomes for those with psoriasis.

Publication Date: August 27th, 2024

Reference: Hjort G, Schwarz CW, Skov L, Loft N. 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

Summary By: Sascha Azoulay