A recent meta-analysis published in JAMA Dermatology has found that smoking, older age, higher BMI, and previous exposure to biologics negatively affect the likelihood of achieving a 90% reduction in Psoriasis Area and Severity Index (PASI) scores in patients treated with biologics.
“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,” the researchers noted. “Therefore, we conducted a meta-analysis on this topic.”
Biologics are a critical treatment option for patients with moderate-to-severe psoriasis, particularly when other treatments have failed. FDA-approved drugs such as tildrakizumab (Ilumya) work by blocking the body’s reactions that cause psoriasis symptoms.
The study aimed to evaluate the association between clinical characteristics and the effectiveness of biologics in treating psoriasis.
Researchers searched PubMed, Embase, and Web of Science from their inception through April 2022 for studies reporting on the response to biologic treatment in psoriasis patients. Only studies that reported PASI 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment were included. The primary outcome measured was PASI 90 at 26 weeks.
Sensitivity analyses were conducted to generate more reliable estimates by excluding studies that only presented univariable results. Although subgroup analyses to determine potential differences in pooled estimates based on different biologics were planned, they could not be completed due to the limited number of studies.
Out of 2322 studies identified through database searches, 23 were included in the final analysis, with an additional 17 studies identified through reference lists, totaling 40 studies with 21,438 patients.
The analysis revealed that 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 randomized controlled trials, a 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).
The researchers acknowledged several limitations, including search strategy limitations, citation bias, possible exclusion of relevant studies, and the inclusion of both univariable and multivariable results. The inability to conduct subgroup analyses further highlights the need for additional research to evaluate the differential effects of clinical characteristics across various biologics.
Despite these limitations, the findings suggest that smoking, older age, higher BMI, and previous exposure to biologics are 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 concluded. “Nonetheless, there are diverse reasons for switching biologics, which include primary and secondary treatment failures, adverse events, participation in clinical trials, and cost.”
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