class of biologic prescribed, substantial improvements in disease activity were attained in all of the assessed clinical outcomes, with slightly lower clinical benefit in response to TNF inhibitors.
There were a few limitations to the study. This was singlecenter study involving a relatively small patient population, and therefore may not be representative of all patient types. Additionally, because this study was conducted in a clinical setting, all patients received some form of active treatment, and no statistical inference can be made on comparability due to the absence of a control group. As this study was not designed prospectively, the distribution of patients within each of the identified subgroups was not balanced. However, it is unlikely that increasing power in groups with relatively fewer patients (eg, 34 biologic-experienced patients vs 66 biologic-naïve patients) would strongly influence the interpretation of our results, as the efficacy outcomes in these groups did not differ appreciably from that in the larger group sizes. Lastly, patients were permitted to use concomitant medications throughout the study period and were able to discontinue or switch treatments at any time. Thus, while these data may not provide an accurate representation of the safety and efficacy of patients solely receiving a single-prescribed biologic, they are representative of what occurs in a real-world setting in which patients use concomitant medications and undergo varying adjustments to their individualized treatment plans.
There were a few limitations to the study. This was singlecenter study involving a relatively small patient population, and therefore may not be representative of all patient types. Additionally, because this study was conducted in a clinical setting, all patients received some form of active treatment, and no statistical inference can be made on comparability due to the absence of a control group. As this study was not designed prospectively, the distribution of patients within each of the identified subgroups was not balanced. However, it is unlikely that increasing power in groups with relatively fewer patients (eg, 34 biologic-experienced patients vs 66 biologic-naïve patients) would strongly influence the interpretation of our results, as the efficacy outcomes in these groups did not differ appreciably from that in the larger group sizes. Lastly, patients were permitted to use concomitant medications throughout the study period and were able to discontinue or switch treatments at any time. Thus, while these data may not provide an accurate representation of the safety and efficacy of patients solely receiving a single-prescribed biologic, they are representative of what occurs in a real-world setting in which patients use concomitant medications and undergo varying adjustments to their individualized treatment plans.
CONCLUSION
Overall, biologic intervention in patients with moderateto-
severe psoriasis appeared to be safe and effective for
the long-term management of psoriasis symptoms. Across
the spectrum of real-world patients included in this study,
commendable efficacy was achieved regardless of the class
of biologic treatment, baseline patient body weight, or prior
biologic experience. Taken together with data from clinical trials,
the current results provide further evidence supporting the use
of biologic therapy in dermatology practice.
DISCLOSURES
Dr. Bagel has received research funds payable to the Psoriasis
Treatment Center of New Jersey from AbbVie, Amgen, Arcutis
Biotherapeutics, Boehringer Ingelheim, Bristol Myers Squibb,
Celgene Corporation, Corrona LLC, Dermavant Sciences, LTD,
Dermira/UCB, Eli Lilly and Company, Glenmark Pharmaceuticals
Ltd, Janssen Biotech, Kadmon Corporation, LEO Pharma,
Lycera Corp, Menlo Therapeutics, Novartis, Pfizer, Regeneron
Pharmaceuticals, Sun Pharma, Taro Pharmaceutical Industries
Ltd, and Valeant Pharmaceuticals; consultant fees from AbbVie,
Amgen, Celgene Corporation, Eli Lilly and Company, Janssen
Biotech, LEO Pharma, Novartis, Sun Pharmaceutical Industries
Ltd, and Valeant Pharmaceuticals; and fees for speaking from
AbbVie, Celgene Corporation, Eli Lilly, Janssen Biotech, and
Novartis. Brianna Butler has no financial interests to declare.Elise Nelson has received consultant fees from Eli Lilly and
Company and LEO Pharma. Alexa Hetzel has received fees for
speaking from Sun Pharmaceutical Industries Ltd. and AbbVie.
ACKNOWLEDGMENT
p-value communications provided medical writing, editing, and publication assistance.
REFERENCES
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2. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-6.
3. Takeshita J, Gelfand JM, Li P, Pinto L, Yu X, Rao P et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135:2955-63.
4. Griffiths CEM, van der Walt JM, Ashcroft DM, Flohr C, Naldi L, Nijsten T et al. The global state of psoriasis disease epidemiology: a workshop report. Br J Dermatol. 2017;177:e4-e7.
5. Griffiths CE, Christophers E, Barker JN, Chalmers RJ, Chimenti S, Krueger GG et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156:258-62.
6. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58:826-50.
7. Strober BE, van der Walt JM, Armstrong AW, Bourcier M, Carvalho AVE, Chouela E et al. Clinical goals and barriers to effective psoriasis care. Dermatol Ther (Heidelb). 2019;9:5-18.
8. Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16:1209-22.
9. Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80:1029-72.
10. Walsh JA, Tan H, Valdez H , Duffin KC. Comparative assessment of PASI and variations of PGA×BSA as measures of psoriasis severity. J Psoriasis Psoriatic Arthritis. 2017;2:113-8.
11. Gottlieb AB, Armstrong AW. Psoriasis outcome measures: a report from the GRAPPA 2012 annual meeting. J Rheumatol. 2013;40:1428-33.
12. Strober B, Bagel J, Lebwohl M, Stein Gold L, Jackson JM, Chen R et al. Efficacy and safety of apremilast in patients with moderate plaque psoriasis with lower BSA: week 16 results from the UNVEIL study. J Drugs Dermatol. 2017;16:801-8.
13. Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD et al. From the Medical Board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76:290-8.
14. Sbidian E, Chaimani A, Garcia-Doval I, Do G, Hua C, Mazaud C et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network metaanalysis. Cochrane Database Syst Rev. 2017;12:CD011535.
15. Feldman SR. Treatment of psoriasis in adults. Updated May 29, 2020. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/ treatment-of-psoriasis-in-adults. Accessed October 26, 2020.
16. Kim IH, West CE, Kwatra SG, Feldman SR , O'Neill JL. Comparative efficacy of biologics in psoriasis: a review. Am J Clin Dermatol. 2012;13:365-74.
17. Clark L, Lebwohl M. The effect of weight on the efficacy of biologic therapy in patients with psoriasis. J Am Acad Dermatol. 2008;58:443-6.
18. Jensen P, Skov L. Psoriasis and obesity. Dermatology. 2016;232:633-9.
19. Kisielnicka A, Szczerkowska-Dobosz A, Nowicki RJ. The influence of body weight of patients with chronic plaque psoriasis on biological treatment response. Postepy Dermatol Alergol. 2020;37:168-73.
20. Puig L. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J Eur Acad Dermatol Venereol. 2011;25:1007-11.
21. Al-Mutairi N, Nour T. The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial. Expert Opin Biol Ther. 2014;14:749-56.
22. Stelara® (ustekinumab) [package insert]. Horsham, PA: Janssen Biotech, Inc.; July 2020.
23. Tremfya® (guselkumab) [package insert]. Horsham, PA: Janssen Biotech, Inc.; July 2020.
2. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70:512-6.
3. Takeshita J, Gelfand JM, Li P, Pinto L, Yu X, Rao P et al. Psoriasis in the US Medicare population: prevalence, treatment, and factors associated with biologic use. J Invest Dermatol. 2015;135:2955-63.
4. Griffiths CEM, van der Walt JM, Ashcroft DM, Flohr C, Naldi L, Nijsten T et al. The global state of psoriasis disease epidemiology: a workshop report. Br J Dermatol. 2017;177:e4-e7.
5. Griffiths CE, Christophers E, Barker JN, Chalmers RJ, Chimenti S, Krueger GG et al. A classification of psoriasis vulgaris according to phenotype. Br J Dermatol. 2007;156:258-62.
6. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58:826-50.
7. Strober BE, van der Walt JM, Armstrong AW, Bourcier M, Carvalho AVE, Chouela E et al. Clinical goals and barriers to effective psoriasis care. Dermatol Ther (Heidelb). 2019;9:5-18.
8. Bagel J, Gold LS. Combining topical psoriasis treatment to enhance systemic and phototherapy: a review of the literature. J Drugs Dermatol. 2017;16:1209-22.
9. Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80:1029-72.
10. Walsh JA, Tan H, Valdez H , Duffin KC. Comparative assessment of PASI and variations of PGA×BSA as measures of psoriasis severity. J Psoriasis Psoriatic Arthritis. 2017;2:113-8.
11. Gottlieb AB, Armstrong AW. Psoriasis outcome measures: a report from the GRAPPA 2012 annual meeting. J Rheumatol. 2013;40:1428-33.
12. Strober B, Bagel J, Lebwohl M, Stein Gold L, Jackson JM, Chen R et al. Efficacy and safety of apremilast in patients with moderate plaque psoriasis with lower BSA: week 16 results from the UNVEIL study. J Drugs Dermatol. 2017;16:801-8.
13. Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD et al. From the Medical Board of the National Psoriasis Foundation: treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017;76:290-8.
14. Sbidian E, Chaimani A, Garcia-Doval I, Do G, Hua C, Mazaud C et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network metaanalysis. Cochrane Database Syst Rev. 2017;12:CD011535.
15. Feldman SR. Treatment of psoriasis in adults. Updated May 29, 2020. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/ treatment-of-psoriasis-in-adults. Accessed October 26, 2020.
16. Kim IH, West CE, Kwatra SG, Feldman SR , O'Neill JL. Comparative efficacy of biologics in psoriasis: a review. Am J Clin Dermatol. 2012;13:365-74.
17. Clark L, Lebwohl M. The effect of weight on the efficacy of biologic therapy in patients with psoriasis. J Am Acad Dermatol. 2008;58:443-6.
18. Jensen P, Skov L. Psoriasis and obesity. Dermatology. 2016;232:633-9.
19. Kisielnicka A, Szczerkowska-Dobosz A, Nowicki RJ. The influence of body weight of patients with chronic plaque psoriasis on biological treatment response. Postepy Dermatol Alergol. 2020;37:168-73.
20. Puig L. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J Eur Acad Dermatol Venereol. 2011;25:1007-11.
21. Al-Mutairi N, Nour T. The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial. Expert Opin Biol Ther. 2014;14:749-56.
22. Stelara® (ustekinumab) [package insert]. Horsham, PA: Janssen Biotech, Inc.; July 2020.
23. Tremfya® (guselkumab) [package insert]. Horsham, PA: Janssen Biotech, Inc.; July 2020.
