Clinical Scorecard: Obesity and Early Biologic Treatment Failure in Psoriasis: A Retrospective Multicentre Real-World Study
At a Glance
Category
Detail
Condition
Clinical topic addressed by the source article: Obesity and Early Biologic Treatment Failure in Psoriasis
Key Mechanisms
The study assessed treatment persistence and discontinuation across TNF-α inhibitors, IL-17 inhibitors, and IL-23 pathway inhibitors, including ustekinumab.
Target Population
Population described in the source article.
Care Setting
Care setting described in the source article.
Key Highlights
Primary failure occurred in 17.0% of treatment lines among patients with obesity and 5.8% among those without obesity.
After multivariable adjustment, obesity was associated with primary failure (HR 2.75, 95% CI 1.59–4.77).
Higher BMI was associated with increased primary failure risk.
Obesity was not significantly associated with secondary failure or safety-related discontinuation.
Among patients with obesity, TNF-α inhibitors had the highest primary failure rate; IL-17 and IL-23 pathway inhibitors had lower adjusted risks than TNF-α inhibitors.
Guideline-Based Recommendations
Diagnosis
The study defined obesity as BMI ≥ 30 kg/m² and also evaluated BMI continuously per 5 kg/m² increment.
Management
The study examined biologic treatment classes but did not provide treatment recommendations.
Monitoring & Follow-up
Treatment persistence was assessed by therapy line, from biologic initiation to discontinuation or last available follow-up.
Discontinuation reasons were categorized as primary failure, secondary failure, or safety-related discontinuation.
Risks
Obesity was associated with higher risk of primary biologic failure after adjustment.
The study found no significant association between obesity and secondary failure or safety-related discontinuation.
Patient & Prescribing Data
Adults with plaque psoriasis receiving biologics in routine care; patients could contribute multiple treatment lines.
Among patients with obesity, TNF-α inhibitors had the highest primary failure rate, while IL-17 and IL-23 pathway inhibitors had lower adjusted risks than TNF-α inhibitors.
Clinical Best Practices
Interpret the findings in the context of a retrospective real-world cohort from five centers in one Italian region.
Distinguish primary failure from secondary failure and safety-related discontinuation when assessing treatment persistence.
The study reassessed baseline covariates at the start of each biologic treatment line.
