To assess whether obesity and increasing BMI were associated with biologic treatment persistence and specific reasons for discontinuation in adults with plaque psoriasis, including differences across biologic classes.
Approach:
Design and setting: Retrospective multicentre cohort study across five dermatology centres in Italy’s Veneto region, using routine-care records.
Participants and analysis: Included adults with plaque psoriasis who received at least one biologic. Analyses used treatment lines as the unit and assessed obesity (BMI ≥30 kg/m²), BMI per 5 kg/m² increase, and discontinuation outcomes.
Outcomes and treatments: Evaluated all-cause discontinuation, primary failure, secondary failure, and safety-related discontinuation across TNF-α, IL-17, and IL-23 pathway inhibitors.
Key Findings:
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.
Interpretation:
In this Italian real-world cohort, obesity was associated with primary biologic treatment failure, with risk increasing alongside BMI. The reported association was specific to primary failure and varied by biologic class.
Limitations:
The study was retrospective and based on routine-care data from five centres in one Italian region.
No formal sample size calculation was performed.
The provided article context does not report the cohort size or full adjusted model details.
Application of newly proposed GRAPPA and EULAR criteria in a longitudinal cohort identified progressively smaller groups of patients with early psoriatic arthritis who experienced persistently worse patient-reported outcomes.
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