Predictive factors of lack of response to adalimumab among bio-naive patients suffering from moderate-to severe psoriasis: analysis of a multicenter data collection in Italy

ABSTRACT

Introduction

Efficacy of anti-TNF-a agents seems inferior to IL-17 and IL-23 inhibitors. Nevertheless, after biosimilars approval, anti TNF-a agents are recommended as first-line for psoriatic patients, for economic reasons.

Methods

Predictive factors of response or non-response to adalimumab in bionaive patients who started adalimumab (originator or biosimilar) over 12 years in 9 dermatologic centers in Italy. Effectiveness was assessed with Psoriasis Area and Severity Index (PASI75 and PASI90) at weeks 12, 24 and 48. Multiple logistic regressions were used for variables predicting clinical response; Kaplan–Meier survival curves and Cox regression for drug survival.

Results

The drug survival analysis showed reduced hazard ratio of overall discontinuation with male gender and scalp localization. In contrast, baseline PASI and genital psoriasis were significantly associated with increased risk of overall discontinuation. Predictive factors of non-response seemed elevated in patients with baseline PASI, older age groups, previously treated patients with phototherapy, females or patients with palmo-plantar while scalp psoriasis, previous cyclosporine and acitretin appeared as a positive predictive factor.

Conclusions

This real-life analysis might be useful for clinicians in case of bio-naive patients with moderate-to-severe psoriasis and various comorbidities.

KEYWORDS:

• Moderate-to-severe psoriasis
• biotechnological therapies
• anti TNF a
• high need patients
• predictive factors

Author contributions

Arianna Zangrilli and Giacomo Caldarola were involved in the conception and design, analysis and interpretation of the data, the drafting of the paper, revising it critically for intellectual content and the final approval of the version to be published. Nicoletta Bernardini, Mauro Bavetta, Dario Graceffa, Claudio Bonifati, Franca Cantoresi, Sara Faleri, Domenico Giordano, Marco Mariani, Adriana Micheli, Gaia Moretta, Federico Pirro, Gianluca Pagnanelli, Vincenzo Panasiti, Alessia Provini, Antonio Richetta, Lidia Sacchelli, Luca Bianchi and Ketty Peris were involved in revising it critically for intellectual content and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.