Dose tapering strategies with biologics in psoriasis may lower the treatment burden over time, while enabling high therapeutic response maintenance in patients benefiting from them. Our results should contribute to developing clinical guidelines to fill the current gap in knowledge on this promising therapeutic approach

Drug survival reflects treatment effectiveness and safety in real life. There is limited data on the variation of drug survival with the availability of additional biological (bDMARDs) or synthetic (sDMARDs) systemic treatments. We aimed to determine whether the increasing number of available systemic treatment in psoriasis over time affects drug survival. We used the Psobioteq cohort, a French prospective observational cohort enrolling patients with moderate to severe psoriasis. All patients initiating a first bDMARD or sDMARD were included. The primary outcome was the comparison of the drug survival over time. A multivariate cox proportional hazard ratio model was computed. There were 1,866 patients included, 739 females (39%) with a median age of 47 years. In multivariate Cox model, no association was found between the calendar year of initiation and drug survival (HR overlapping from 0.80 (0.42-1.52) to 1.17 (0.64-2.17), p=0.633). In conclusion, drug survival in psoriasis is not affected by the year of initiation.

<b><i>Background:</i></b> Obesity is associated with an increased risk of psoriasis. <b><i>Objective:</i></b> In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis. <b><i>Methods:</i></b> In this cohort study, we compared obese (BMI ≥30 kg/m²) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival. <b><i>Results:</i></b> A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36–56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients (<i>p</i> &#x3c; 2.10^–4) and was worse for obese than non-obese patients for UST (<i>p</i> = 0.009) and ETA (<i>p</i> = 0.02), with no difference for ADA (<i>p</i> = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23–2.96], <i>p</i> = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04–2.19). <b><i>Conclusion:</i></b> This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes.

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