What Factors Impact Treatment Outcomes in Psoriasis?

Patients on TNFi or IL-17i have lower odds of achieving treatment outcomes with comorbid obesity and history of diabetes

By Dermsquared Editorial Team | December 22, 2021

For psoriasis patients on tumor necrosis factor inhibitors (TNFi) or interleukin-17 inhibitors (IL-17i), comorbid obesity and history of diabetes are associated with reduced odds of achieving treatment outcomes, according to a study published in the January issue of the Journal of the American Academy of Dermatology.

Clinton W. Enos, M.D., from the Eastern Virginia Medical School in Norfolk, and colleagues examined possible associations of comorbid obesity, history of diabetes, hypertension, and hyperlipidemia with response to biologic treatment among 2,924 patients with psoriasis initiating biologic therapy. Participants had baseline and six-month follow-up visits.

The researchers found that obesity was associated with reduced odds of achieving a 75 percent or greater reduction in the Psoriasis Area Severity Index (PASI75) or PASI90 (odds ratios, 0.75 and 0.70, respectively). A history of diabetes was also associated with reduced odds of achieving PASI75 or PASI90 (odds ratios, 0.69 and 0.79, respectively). A lower response to TNFi and IL-17i classes was seen in association with obesity. Diabetes was associated with poorer outcomes when patients were taking IL-17i therapy, and to a lesser extent, hypertension was associated with poorer outcomes with the TNFi class, independent of obesity. There were no significant associations seen in the hyperlipidemia group.

"Our study highlights the potential importance of screening for comorbidities and developing a personalized treatment plan for psoriasis patients," the authors write. "Additional research is needed to better understand the underlying mechanisms of these associations and to determine if higher dosing or dose escalation is necessary to achieve an optimal response in these patients."

Several authors disclosed financial ties to pharmaceutical companies; CorEvitas (formerly Corrona) funded the study and analysis.

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