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Several factors including female sex, hyperlipidemia, and Medicaid enrollee status were associated with multiple biologic failure in patients with psoriasis. Consequently, these features could help identify patients who would benefit from more frequent follow-up.

The study was published in . The prospective cohort analysis assessed data from 1,039 patients.

Study co-author, Wilson Liao, MD, is a professor of dermatology and director of the with the University of California, San Francisco. His exchange with the Reading Room has been edited for length and clarity.

What was the goal of your study?

Liao: We set out to understand whether there were any differences between psoriasis patients who fail multiple biologic therapies and psoriasis patients who respond to the first biologic tried.

In the clinic, managing patients who fail multiple biologic therapies is quite difficult, so we hoped this study would provide some insight.

How would you summarize your key findings?

Liao: Using the , we found that patients who failed multiple biologic therapies were more likely to be women. The same was true for patients who had a shorter duration of psoriasis, an earlier year of biologic initiation, and also for those who had received prior nonbiologic systemic therapies, had hyperlipidemia, and who had Medicaid insurance.

Did anything surprise you about the study or its findings?

Liao: It was very interesting that female sex was found to be associated with multiple biologic failure. It was also surprising that hyperlipidemia was associated with multiple biologic failure, which suggests that certain comorbidities may be a marker of harder-to-treat psoriasis.

Based on these findings, what advice or suggestions might you offer dermatologists?

Liao: Our study requires additional follow-up studies before any definitive recommendations can be made, but it highlights that the patient groups I've described here may benefit from closer follow-up before a biologic for psoriasis is initiated.

The topic of multiple biologic failure is of significant interest to the psoriatic disease community. Additional projects in this area are underway with the National Psoriasis Foundation and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.