Identifying demographic, social and clinical predictors of biologic therapy effectiveness in psoriasis: a multicentre longitudinal cohort study

Background Biologic therapies have revolutionized the treatment of moderate-to-severe psoriasis. However, for reasons largely unknown, many patients do not respond or lose response to these drugs. Objectives To evaluate demographic, social and clinical factors that could be used to predict effectiveness and stratify response to biologic therapies in psoriasis. Methods Using a multicentre, observational, prospective pharmacovigilance study (BADBIR), we identified biologic-naive patients starting biologics with outcome data at 6 (n = 3079) and 12 (n = 3110) months. Associations between 31 putative predictors and outcomes were investigated in univariate and multivariable regression analyses. Potential stratifiers of treatment response were investigated with statistical interactions. Results Eight factors associated with reduced odds of achieving >= 90% improvement in Psoriasis Area and Severity Index (PASI 90) at 6 months were identified (described as odds ratio and 95% confidence interval): demographic (female sex, 0 center dot 78, 0 center dot 66-0 center dot 93); social (unemployment, 0 center dot 67, 0 center dot 45-0 center dot 99); unemployment due to ill health (0 center dot 62, 0 center dot 48-0 center dot 82); ex- and current smoking (0 center dot 81, 0 center dot 66-0 center dot 99 and 0 center dot 79, 0 center dot 63-0 center dot 99, respectively); clinical factors (high weight, 0 center dot 99, 0 center dot 99-0 center dot 99); psoriasis of the palms and/or soles (0 center dot 75, 0 center dot 61-0 center dot 91); and presence of small plaques only compared with small and large plaques (0 center dot 78, 0 center dot 62-0 center dot 96). White ethnicity (1 center dot 48, 1 center dot 12-1 center dot 97) and higher baseline PASI (1 center dot 04, 1 center dot 03-1 center dot 04) were associated with increased odds of achieving PASI 90. The findings were largely consistent at 12 months. There was little evidence for predictors of differential treatment response. Conclusions Psoriasis phenotype and potentially modifiable factors are associated with poor outcomes with biologics, underscoring the need for lifestyle management. Effect sizes suggest that these factors alone cannot inform treatment selection.