Systemic Agent Initiation for Psoriasis Is Highest in Spring

Seasonal variations in psoriasis therapy initiation may help guide resource management.

The initiation of systemic agents for psoriasis peaks in spring and decreases in summer and fall, according to findings from a study published in JID Innovations.

The retrospective ecological study assessed seasonal patterns in the initiation, discontinuation, and switching from systemic agents in patients with psoriasis.

Data were obtained from the Optum Clinformatics Data Mart, which contained health care information from all 50 states in the United States. Participants were diagnosed with psoriasis before December 31, 2019, and were enrolled in the database from January 1, 2016 through December 31, 2019. The exposure was periods of seasons, and the outcomes were incidence of initiating, switching from, and discontinuing a systemic drug.

A total of 360,787 patients with psoriasis had a risk of initiating any systemic drugs from 2016 to 2019. Their mean age was 54.2 years (SD 18.2), 52.5% were female, and 6.4% had psoriatic arthritis. Of the cohort, 39,572 patients were at risk of discontinuing or switching from any biologic agents, and 35,388 patients were at risk of discontinuing or switching from any nonbiologic systemic drugs.

Discontinuing ineffective drugs and switching to alternative systemic drugs among individuals who use medications in reaction to psoriasis symptoms might be a key component in reducing the risk of psoriasis worsening.

The overall initiation of biologic agents was higher compared with nonbiologic systemic agents (0.9%-1.4% vs 0.8%-1.1%, respectively). The initiation of nonbiologic systemic agents peaked in spring (0.9%-1.1%). The mean incidence for biologic therapy initiation (95% CI) also was greatest in spring (1.28% [1.25%-1.30%]), followed by summer (1.11% [1.08%-1.13%], fall (1.08% [1.06%-1.10%], and winter (1.01% [0.99%-1.03%]).

Meta-regression analysis confirmed that initiation of biologic agents was highest in spring. The incidence of initiating biologic overall, compared with spring, was 13% lower in summer (relative rate [RR], 0.87; 95% CI, 0.82-0.92), 16% lower in fall (RR, 0.84; 95% CI, 0.84-0.95), and 21% lower in winter (RR, 0.79; 95% CI, 0.69-0.91).

Male participants had a higher mean incidence of initiation of systemic agents compared with female individuals in all seasons (1.16%-1.45% vs 0.88%-1.12%), with a similar seasonal difference.

The incidence of systemic agent initiation was highest in participants 30 to 39 years of age. Patients with psoriatic arthritis were at least 5 times more likely to initiate any biologic agents compared with those without psoriatic arthritis (mean incidence 4.19%-5.10% vs 0.78%-0.99%). The incidence of any biologic agent initiation appeared to be greater among individuals living in the South and Midwest regions compared with the West and Northeast regions of the country.

The incidence of discontinuation was lower for biologic agents (11.3%-15.0%) vs nonbiologic systemic agents (14.9%-19.2%) across seasons, with the largest difference occurring in spring. For nonbiologic systemic therapy, the mean incidence of discontinuation appeared to be greater in spring and summer. Meta-regression analysis found that the incidence of discontinuation of biologic agents overall was 7% higher in summer compared with spring (RR, 1.07, 95% CI, 1.07-1.07) but was not significantly different in fall (RR, 0.99; 95% CI, 0.93-1.06) and winter (RR, 1.00; 95% CI, 0.90-1.12).

The incidence of switching was greater for individuals who used biologic agents (0.03%-0.15%) vs nonbiologic systemic agents (0%-0.10%) across all seasons. Switching nonbiologic therapies did not have a clear pattern. The mean incidence for switching from biologic therapy (95% CI) in winter was 0.07% (95% CI, 0.04%-0.09%) compared with 0.12% (95% CI, 0.09%-0.15%) in spring and 0.08% (95% CI, 0.06%-0.11%) in summer and fall. Meta-regression analysis did not show a statistically significant seasonal effect on the incidence of switching for biologics, although the point estimate suggested a trend for higher switching occurring in summer.

Among several limitations, no causal relationship can be made from the findings, and patients with rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, and other conditions for which certain biologic agents may be indicated were not excluded. Also, the participants were covered by commercial insurance.

“Discontinuing ineffective drugs and switching to alternative systemic drugs among individuals who use medications in reaction to psoriasis symptoms might be a key component in reducing the risk of psoriasis worsening,” stated the investigators. “Future research may focus on specific systemic drug survival rate and switching patterns among patients with certain comorbidities.”

Disclosure: The design, study conduct, and financial support for the study were provided by AbbVie. Several of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Liang H, Kirk B, Polinski JM, Yue X, Kilpatrick RD, Gelfand JM. Impact of season and other factors on initiation, discontinuation and switching of systemic drug therapy in patients with psoriasis — a retrospective study. JID Innov. Published online November 15, 2022. doi: j.xjidi.2022.100171