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Difficult-to-Treat Psoriasis

This meta-analysis of psoriasis treatments shows that biologic therapies may be less effective in certain psoriasis (PSO) patients, particularly those who are older, smokers, with higher BMI an prior exposure to biologics.

This analysis included 40 studies and 21 438 PSO patients treated with biologics with reported skin (PASI 90) outcomes. 

A negative effect was seen with:

  • Older age (odds ratio [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). In RCTs, only 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).
  • Previous smoking (OR, 0.81; 95% CI, 0.67-0.98), and current smoking (OR, 0.78; 95% CI, 0.66-0.91) 

Clinical characteristics may help define psoriasis patients who are difficult to treat. 


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The author has no conflicts of interest to disclose related to this subject