Response to Biologics During the First Six Months of Therapy in Biologic-naïve Patients with Psoriasis Predicts Risk of Disease Flares: A Danish Nationwide Study
Nikolai Loft, Alexander Egeberg, Mads Kirchheiner Rasmussen, Lars Erik Bryld, Christoffer V. Nissen, Tomas Norman Dam, Kawa Khaled Ajgeiy, Lars Iversen, Lone Skov
Early response to treatment with biologics might be important for the stability of psoriasis and long-term outcome. The aim of this study was therefore to assess whether risk of flares and drug survival are associated with disease activity in the first 6 months of treatment of psoriasis with biologics. Biologic-naïve patients from the Danish nationwide registry, DERMBIO, were grouped based on absolute Psoriasis Area and Severity Index (PASI) during the first 6 months of treatment, as: PASI = 0, PASI > 0–≤2, PASI > 2–≤ 4, and PASI > 4. Among 1,684 patients, 746 achieved PASI= 0, 485 PASI > 0–≤2, 246 PASI > 2–≤4, and 207 PASI > 4. Longer flare-free period and drug survival were observed for patients with lower PASI in the first 6 months of treatment (adjusted hazard ratios for flares (95% confidence interval) with PASI= 0 as reference: PASI > 0–≤2 (1.35 (1.11–1.72]), PASI > 2–≤ 4 (2.32 [1.80–2.99]), and PASI > 4 (2.38 [1.80–3.15])). In conclusion, a low PASI in the first 6 months of treatment with biologics in biologic-naïve patients with psoriasis was associated with a more stable disease course, lower risk of flares, and longer drug survival.
Treatment of psoriasis with biologics is often initiated and evaluated based on objective disease severity measures, such as the Psoriasis Area and Severity Index (PASI). The optimal response criteria have been widely discussed and, currently, a PASI≤2 is considered a good response. However, limited knowledge exists about the long-term consequences of different response criteria. This study found that patients who respond better to treatment in the first 6 months of therapy have a lower risk of disease flaring and a lower risk of discontinuing treatment.