Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: A 2015-2022 prospective cohort analysis of the CorEvitas psoriasis registry

Joy Q Jin; Angel Cronin; Carla Roberts-Toler; Samuel Yeroushalmi; Edward Hadeler; Riley K Spencer; Kareem G Elhage; George Gondo; Elizabeth B Wallace; Soumya M Reddy; George Han; Jessica Kaffenberger; Mitchell S Davis; Marwa Hakimi; Jose U Scher; April W Armstrong; Tina Bhutani; Robert R McLean; Wilson Liao

doi:10.1016/j.jaad.2023.06.058

Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: A 2015-2022 prospective cohort analysis of the CorEvitas psoriasis registry

J Am Acad Dermatol. 2023 Nov;89(5):974-983. doi: 10.1016/j.jaad.2023.06.058. Epub 2023 Jul 24.

Authors

Joy Q Jin¹, Angel Cronin², Carla Roberts-Toler², Samuel Yeroushalmi³, Edward Hadeler³, Riley K Spencer³, Kareem G Elhage³, George Gondo⁴, Elizabeth B Wallace⁵, Soumya M Reddy⁶, George Han⁷, Jessica Kaffenberger⁸, Mitchell S Davis³, Marwa Hakimi³, Jose U Scher⁶, April W Armstrong⁹, Tina Bhutani³, Robert R McLean², Wilson Liao¹⁰

Affiliations

¹ School of Medicine, University of California San Francisco, San Francisco, California; Department of Dermatology, University of California San Francisco, San Francisco, California.
² CorEvitas, LLC., Waltham, Massachusetts.
³ Department of Dermatology, University of California San Francisco, San Francisco, California.
⁴ National Psoriasis Foundation, Portland, Oregon.
⁵ Cherry Hills Dermatology, Englewood, Colorado.
⁶ Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center, New York, New York.
⁷ Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
⁸ Division of Dermatology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
⁹ Department of Dermatology, University of Southern California, Los Angeles, California.
¹⁰ Department of Dermatology, University of California San Francisco, San Francisco, California. Electronic address: wilson.liao@ucsf.edu.

PMID: 37495173
DOI: 10.1016/j.jaad.2023.06.058

Abstract

Background: Psoriasis patients with poor therapeutic response to multiple biologic agents are not well-characterized.

Objective: To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic.

Methods: This prospective cohort analysis evaluated patients in the multicenter CorEvitas Psoriasis Registry who initiated their first biologic between 2015 and 2020 and were followed for ≥24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued ≥2 biologics of different classes, each used for ≥90 days, due to inadequate efficacy) and GR (continued use of first biologic for ≥2 years) patients.

Results: One thousand thirty-nine patients were analyzed (490 GR [47.2%], 65 MBF [6.3%]). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior nonbiologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter 2 variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was Tumor necrosis factor-α inhibitor to IL-17 inhibitor use.

Limitations: Biologic adherence between visits was not evaluated.

Conclusion: Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.

Keywords: biologic; biologic failure; biological agent; multiple biologic failure; prospective cohort study; psoriasis; systemic therapy; therapeutic failure; treatment characteristics.