Proportions of Biologic Discontinuation Among Psoriasis Patients With Metabolic Comorbidities

Background: Among psoriasis patients, the presence of metabolic comorbidities associates with poorer response to biologics. How the presence of comorbidity impacts treatment patterns with biologics is not fully understood.

Methods: Adult patients in the CorEvitas Psoriasis Registry were included if they initiated biologic therapy between 5/2015-12/2019 and had a 6-month follow-up visit. The frequency of biologic discontinuations by 6-months were calculated by metabolic comorbidity status (current obesity and histories of hypertension [HTN], diabetes [DM], and hyperlipidemia [HLD]) for all patients and by drug class (tumor necrosis factor inhibitors [TNFi], interleukin-17i [IL-17i], and IL-23i or IL-12/23i).

Results: Among the 2924 participants, discontinuations were more frequent in those with obesity (17%, P < .01) or DM (20%, P < .001) compared to those without these (13% and 14%, respectively). Discontinuations were similar for those with and without histories of HTN or HLD. Frequencies of discontinuation for each biologic class were: TNFi (26%), IL-17i (16%), and IL-23i or IL-12/23i (9%). Among TNFi initiators, the proportions of discontinuations were greater in the presence of obesity (30%, P < .05), DM (34%, P < .05), or HTN (34%, P < .01) compared to those without (22%, 24%, and 22%, respectively). Of the IL-23i or IL-12/23i initiators, discontinuations were more frequent in those with obesity (11%, P < .01) or with DM (13%, P < .05) compared to those without (7% and 8%, respectively). Discontinuations did not statistically differ between comorbidity groups in IL-17i initiators.

Conclusion: Comorbid disease status, especially obesity and DM, should be assessed at biologic initiation as it may predict a less optimal clinical outcome.