Characterization and treatment outcomes of biologic therapy in super-responders and biologic-refractory psoriasis patients: A single-center retrospective study in China

Despite advances in the availability of effective biologics in psoriasis over the past decade, clinical characteristics, persistence, and safety associated with treatment response have never been systemically investigated. To evaluated the factors, persistence and safety associated with super response (super-responder, SR) or refectory (biologic-refractory patient, BRR) to biologic agents, we conduct a retrospective analysis of psoriasis patients who initiated their first biologic therapy at the Department of Dermatology of Xiangya Hospital. In total, 737 patients were included (140 SRs [19.0%], 34 BRPs [4.6%]). We found normal body mass index, low Charlson Co-morbidity Index, without psoriatic arthritis, with family history of psoriasis, and low insulin resistance level were significantly associated with SRs, whereas obesity, with non-alcoholic fatty liver disease, high psoriasis area and severity index, and high erythrocyte sedimentation rate level were independent predictors of BRPs. SRs were associated with treatment persistence of biologics, but BRPs were linked with poor persistence and higher incidences of adverse events—particularly paradoxical eczema. In conclusion, our study identified predictors of response which may facilitate accurate drug targeting with good persistence and reassuring safety for psoriasis patients.

尽管过去十年中，银屑病有效生物制剂的可用性取得了显著进展，但与治疗反应相关的临床特征、持久性和安全性尚未得到系统性研究。为了评估与生物制剂的超反应（超级反应者，SR）或反应性恢复（生物制剂耐药患者，BRR）相关的因素、持久性和安全性，我们对在湘雅医院皮肤科首次接受生物治疗的银屑病患者进行了回顾性分析。总计纳入737名患者（140名SR[19.0%]，34名BRP[4.6%]）。我们发现，正常的体重指数、低的Charlson合并症指数、无银屑病关节炎、具有银屑病家族史以及低胰岛素抵抗水平与SRs显著相关，而肥胖、非酒精性脂肪性肝病、高银屑病面积和严重程度指数以及高红细胞沉降率水平则是BRPs的独立预测因素。SRs与生物制剂的治疗持久性相关，但BRPs与治疗持久性差和不良事件发生率高——尤其是矛盾性湿疹——相关。总之，我们的研究确定了反应的预测因素，这些因素可能有助于实现针对银屑病患者的准确药物靶向，并确保良好的持久性和令人安心的安全性。