Real-World Outcomes and Predictors of Response to Biologic Therapy in Moderate-to-Severe Psoriasis: A Prospective Cohort Study
Abstract
Background & Objective: Psoriasis is a chronic immune-mediated inflammatory skin disease, requires long-term systemic therapy, and biologic agents are increasingly used in moderate-to-severe psoriasis. To assess clinical outcomes in the real world and ascertain predictors of response to biologic therapy in patients with moderate-to-severe psoriasis. Methodology: This was a prospective cohort study, carried out at a tertiary care center, District Headquarters Teaching Hospital (DHQ Teaching Hospital), KDA, Kohat, between January 2022 and December 2024. Consecutive sampling was used to enroll 358 patients with moderate-to-severe psoriasis taking biologic therapy, of whom 328 completed12-month follow-up. PASI75, PASI90, and PASI100 responses were used to measure outcomes. Multivariable logistic regression was used to identify independent predictors of treatment response. Results: At 12 months, PASI75 response was achieved in 72.56% (238/328) patients, PASI90 in 56.10% (184/328), PASI100 in 29.27% (96/328). IL-17 inhibitors demonstrated higher PASI75 response (82.69%) compared to IL-23 (77.78%) and TNF-α inhibitors (59.65%). Treatment persistence was observed in 70.73%, while 11.59% discontinued therapy. Responders (n = 238) were significantly younger than non-responders (41.52 +_12.98 vs 46.31 +_ 13.87 years, p = 0.003) and demonstrated lower proportion of disease duration >10 years (38.65% vs 60.00%, p = 0.001), obesity (28.57% vs 48.89%, p < 0.001), and presence of comorbidities (55.46% vs 75.56%, p = 0.001). Independent predictors of improved response included younger age, lower BMI, shorter disease duration, absence of comorbidities and use of IL-17/IL-23 inhibitors. Conclusion: Biologic therapy is highly effective in real-world management of moderate-to-severe psoriasis with IL-17 and IL-23 inhibitors showing superior outcomes and patient-related factors significantly influencing therapeutic response. Key Words: Psoriasis, Biological Treatment, Predictors, Outcomes.