Prior Biologic Agent Use Potential Predictor of Psoriasis Treatment Response

Psoriasis on elbow
Psoriasis on elbow
The effect of differences in patient characteristics on relative psoriasis treatment effectiveness was evaluated.

Prior biologic agent use may affect future treatment response in patients with moderate to severe plaque psoriasis, results from a network meta-analysis published in the British Journal of Dermatology suggest. 

Investigators pooled data from 9 network meta analyses completed as part of the National Institute for Health and Care Excellence (NICE)’s Single Technology Appraisals of second-line psoriasis treatments. Although NICE’s appraisals of psoriasis treatments are used for guideline development, significant heterogeneity in network studies can affect the reliability of results. Investigators sought to assess the effect of 4 patient characteristics on relative treatment efficacy: race/ethnicity, weight, baseline Psoriasis Severity Index (PASI) score, and prior exposure to biologic agent. In all, 4 networks were constructed based on these characteristics: 1) a network in which 90% or more of patients were White; 2) a network in which mean patient weight was 90kg or less; 3) a network in which mean baseline PASI score was 25 or less; and 4) a network in which fewer than 25% of patients had prior biologic agent use. The estimated effects of each psoriasis treatment were compared across these 4 smaller networks and the pooled network of all NICE analyses.  

The total patient cohort comprised 34,924 patients from 69 randomized controlled trials. As the researchers expected, the 4 smaller networks had lower between-study heterogeneity than the pooled network. The lowest heterogeneity was observed in the network in which less than 25% of patients had received prior treatment with biologic agents. When 75% improvement on PASI score (PASI75) was used as a response metric, ixekizumab had the highest median treatment ranking in 4 of 5 patient networks. In the network of 90% or more White patients, secukinumab was the most efficacious drug, followed by ixekizumab.

Estimated effects were also comparable across the 5 networks. Anti-tumor necrosis factor (TNF) drugs infliximab and certolizumab pegol had higher rankings in the network with less than 25% prior biologic agent use compared with the other 4 networks. However, the credible intervals were large for both these estimates, suggesting uncertainty. Prior studies have suggested that patients with biologic agent experience are more likely to have received anti-TNF therapy. This reported effect may explain the low infliximab and certolizumab pegol rankings in the 4 networks in which 25% or less of patients had prior biologic agent exposure.

These results suggest that prior biologic agent use may modify the effects of certain psoriasis treatments, particularly anti-TNF drugs. “Future [meta-analyses] of psoriasis treatments should consider the subgroup of biologic-naïve patients and the subgroup of biologic-experienced patients,” investigators wrote.

Disclosure: One study author declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.


Wade R, Sharif-Hurst S, Smith C, Dias S. Characteristics modifying response to biologic treatments for psoriasis: considering subgroups in network meta-analysis [published online August 19, 2020]. Br J Dermatol. doi: 10.1111/bjd.19494