First-Line Biologic Therapy and Obesity in Moderate-to-Severe Psoriasis: Results from the Prospective Multicenter Cohort Psobioteq

Abstract

<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.