Treatment Refractory and Super-Responders in Psoriasis Biologic Agent Treatment

Researchers sought to recognize and describe the patients with psoriasis at both ends of the biologic agent treatment spectrum.

In patients with psoriasis treated with biologic agents, a small percentage will achieve unwarranted success and a small percentage will have virtually no success, according to study findings published in the Journal of the European Academy of Dermatology and Venereology.

Some patients with psoriasis treated with biologic agents become super-responders and achieve and remain psoriasis clear for years. However, a few patients at the other end of the response-to-treatment spectrum, treatment refractory, do not respond to biologic agent treatment or they lose whatever gains they had achieved. Researchers sought to recognize and describe the patients at the biologic treatment spectrum ends.

To accomplish this, they conducted a retrospective study of 3280 patients (mean age, 45.0 years; 37% women) treated with biologic agents for psoriasis in Denmark hospitals and registered in DERMBIO from January 2007 to November 2019. They identified a cohort of 214 patients (6.5%; mean age 43.1 years; 41% women) as treatment refractory defined by failure to respond to 3 or more biologic agents that targeted 2 or more pathways. They also identified a cohort of 207 patients (6.3%; mean age, 44.8 years; 35% women) with an initial psoriasis severity index (PASI) greater than 3, as super-responders defined by total clearing of psoriasis for at least 5 years due to treatment with their first biologic agent. The remaining 2859 patients in DERMBIO represented the control group.

Compared with the control group, the treatment refractory cohort had higher mean body weight (100.6 kg vs 90.6 kg; P <.0001) and higher mean body mass index (BMI) (32.2 vs 29.4; P <.0001), and no significant differences for psoriatic arthritis, comorbidities, or smoking. Compared with the control group, the super-responder cohort had higher socioeconomic status (64% vs 38% in the 2 highest groups), fewer additional illnesses (P <.0001), and a reduced percentage of ever-smokers (51% vs 62%, P <.0039).

Study limitations included missing data, lack of information on treatment adherence or drug levels, and selection bias in the super-responder cohort.

Researchers concluded that, “approximately 6% of patients treated with [biologic agents] have treatment refractory psoriasis and 6% are super-responders. Those who have treatment refractory psoriasis had higher body weight whereas those who were super-responders had fewer comorbidities and higher socioeconomic status.” They suggest that genetic and biological differences in patients should be investigated in additional studies.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Loft N, Egeberg A, Rasmussen MK, et al. Prevalence and characterization of treatment-refractory psoriasis and super-responders to biologic treatment: a nationwide study. J Eur Acad Dermatol Venereol. Published online April 2, 2022. doi:10.1111/jdv.18126