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. 2021 Oct;41(10):917-925.
doi: 10.1007/s40261-021-01080-z. Epub 2021 Sep 18.

Impact of Body Mass Index on the Efficacy of Biological Therapies in Patients with Psoriasis: A Real-World Study

Federico Pirro #  1   2 , Giacomo Caldarola #  3   4 , Andrea Chiricozzi  3   4 , Martina Burlando  5 , Marco Mariani  6 , Aurora Parodi  5 , Ketty Peris  3   4 , Clara De Simone  3   4
Affiliations

Impact of Body Mass Index on the Efficacy of Biological Therapies in Patients with Psoriasis: A Real-World Study

Federico Pirro et al. Clin Drug Investig. 2021 Oct.

Abstract

Background: The efficacy of biological therapies used for the treatment of chronic plaque psoriasis can be influenced by numerous variables including body mass index (BMI).

Objective: This study aimed to evaluate the impact of BMI on the short-term and long-term efficacy of biological therapies in clinical practice and to identify the best therapeutic options in obese patients (BMI ≥ 30 kg/m2).

Methods: A multicentric retrospective study was conducted in patients who initiated a biological therapy during the period January 2006-December 2019. The proportion of patients achieving a 90% improvement of baseline Psoriasis Area and Severity Index at weeks 12 and 24 was calculated also recording the 12- and 24-month drug survival as a measure of long-term efficacy, performing multivariate analyses to assess the impact of different variables.

Results: Five hundred and four patients with psoriasis were included. After 12 and 24 weeks, the proportion of patients achieving a 90% improvement of baseline Psoriasis Area and Severity Index response was higher in patients with a BMI < 30 kg/m2 compared with those with a BMI ≥ 30 kg/m2 [54.90% vs 43.45% (p = 0.014) at week 12 and 66.84% vs 56.55% (p = 0.021) at week 24]. The Kaplan-Meier survival curves showed how obese patients had a higher probability of discontinuation due to a lack or loss of efficacy (p = 0.0192) compared with non-obese patients. The drug survival analysis also showed that BMI negatively affected the drug survival of secukinumab (odds ratio 1.27, p < 0.001) and ustekinumab (odds ratio 1.06, p = 0.050), while the long-term efficacy of adalimumab, etanercept, and ixekizumab was not influenced by BMI.

Conclusions: Obesity (BMI ≥ 30 kg/m2) negatively affects the clinical response of biological drugs in psoriatic patients, with anti-interleukin drugs being more affected by BMI than anti-tumor necrosis factor drugs.

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Conflict of interest statement

Giacomo Caldarola reports consulting fees or honorarium and payment for lectures from Lilly and Novartis, outside the submitted work. Andrea Chiricozzi reports consulting fees or honorarium from Abbvie, Novartis, Lilly, Leo Pharma, Janssen, Sanofi, UCB Pharma, and Pfizer, outside the submitted work. Clara De Simone reports consulting fees or honorarium from Abbvie, Amgen, Novartis, Celgene, Sanofi, UCB Pharma, Janssen, and Lilly and payment for lectures from Abbvie, Lilly, Novartis, UCB Pharma, and Celgene, outside the submitted work. Ketty Peris reports consulting fees or honorarium from Almirall, AbbVie, Biogen, Lilly, Celgene, Galderma, Leo Pharma, Novartis, Pierre Fabre, Sanofi, Sandoz, Sun Pharma, and Janssen, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Fig. 1
Fig. 1
Proportions of patients achieving a 90% improvement of the baseline Psoriasis Area and Severity Index (PASI90) response
Fig. 2
Fig. 2
Kaplan–Meier curves of drug survival. a Overall survival (p > 0.05), b discontinuation because of adverse events (p > 0.05), and c discontinuation because of a lack or loss of efficacy (p = 0.0192)
See this image and copyright information in PMC

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