Black Patients, Psoriasis, and Biologic Agents

Dermatitis. Afro man scratching itch on his hand, cropped, white background
Rates of biologic agent use in minority patients with psoriasis compared with White patients were determined in this study.

Patients who are Black or those who belong to other racial minority groups are less likely to use biologic agents to treat  their psoriasis than patients who are White, which may partially be attributed to several socioeconomic factors, according to a study published in the British Journal of Dermatology.

The study was a retrospective analysis of medical record data from the Washington University School of Medicine. A total of 4413 patients with psoriasis who were treated with only systemic therapies from 2010 to 2019 were included in the study cohort. The investigators of this study examined the prevalence of biologic agent use in these patients. Biologic agents included in the analysis were TNF-alpha inhibitors, IL-12/23 inhibitors, and IL-23 inhibitors.

Patients were classified as White (n=4016; mean age, 56.2 years), Black (n=291; mean age, 54.8 years), or other (n=106; mean age, 53.4 years). It was found that Black patients had a lower biologic agent utilization rate compared with White patients (51.9% vs 62.2%, respectively; odds ratio [OR], 0.65; 95% CI, 0.52-0.83). In addition, patients who were Black were significantly less likely to use TNF-alpha inhibitors (37.5% vs 48.4%; OR, 0.64; 95% CI, 0.50-0.82) than White patients.

Researchers observed a trend towards less utilization of IL-17 inhibitors (11.0% vs 14.1%; OR, 0.75; 95% CI, 0.51-1.09), and no differences were found in regard to the use of IL-12/23 or IL-23 inhibitors. Patients who were Black were more likely to use a topical therapy and a systemic therapy compared with patients who were White (80.4% vs 65.2%, respectively; OR, 2.19; 95% CI, 1.63-2.95).

Patients who identified as other race categories (Asian, American Indian, Alaskan Indian, other Pacific Islander, and Unknown) also had a lower biologic agent use rate (46.2% vs 62.2%; OR, 0.52; 95% CI, 0.35-0.77) compared with White patients. There was a trend in the other race categories toward greater use of nonbiologic systemic therapies (75.5% vs 69.2%; OR, 1.37; 95% CI, 0.87-2.14), and no difference was found in terms of the use of topical therapies (65.1% vs 65.2%; OR, 0.99; 95% CI, 0.66-1.49).

This study was predominantly limited by its cross-sectional, single-center, and retrospective design.

According to the investigators, previous findings suggest socioeconomic factors may partially explain the lower biologic agent utilization rate in Black patients with psoriasis. The investigators noted that additional “studies are necessary to evaluate potential confounders and to further explore the causes of this difference in biologics utilization” between racial and ethnic groups.


Hodges WT, Bhat T, Raval NS, et al. Biologics utilization for psoriasis is lower in Black compared to Caucasian patients. Br J Dermatol. Published online February 10, 2021. doi:10.1111/bjd.19876