Clinical predictors of non-response to any tumor necrosis factor (TNF) blockers: a retrospective study

J Dermatolog Treat. 2014 Feb;25(1):73-4. doi: 10.3109/09546634.2013.800184. Epub 2013 May 21.


Background: Anti-tumor necrosis factor (TNF)-α therapies represent a significant innovation in therapy for psoriasis. However, a significant number of psoriasis patients do not respond well to TNF blockers or show an insufficient control of disease activity on a long-term basis.

Objective/aim: The aim of this study was to recognize specific clinical factors that could be associated with a non-response to any available TNF blockers in patients with moderate-to-severe plaque psoriasis.

Materials and methods: The authors reviewed the medical records of all patients who had started etanercept, infliximab, adalimumab and had achieved a minimum of 24 months follow-up. The authors identified subjects who were not responsive to all available anti-TNF agents, whatever the chronology of their use.

Results: A total of 110 patients were retrospectively examined. Thirteen patients were identified as "non-responders" to all available TNF-α blockers. Current smoking at the start of anti-TNF therapy was associated with non-response to TNF blockers. The group of "non-responders" presented a high mean body mass index and a high baseline PASI score with respect to the group of responders.

Conclusions: The data showed that the majority of non-responder patients were smokers, overweight or obese and had a high baseline PASI score. Concomitant arthritis was not significantly associated with non-response.

MeSH terms

  • Adalimumab
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Body Mass Index
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / therapeutic use*
  • Infliximab
  • Male
  • Middle Aged
  • Psoriasis / drug therapy*
  • Psoriasis / pathology
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Retrospective Studies
  • Smoking / adverse effects
  • Treatment Failure
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • Young Adult


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • Adalimumab
  • Etanercept