Factors Predicting Persistence of Biologic Drugs in Psoriasis: A Systematic Review and Meta‐Analysis

Abstract

Background

Long‐term therapy of psoriasis is impaired by gradual loss of effectiveness and treatment discontinuation. Identifying factors that affect biologic drug survival may help in treatment optimization.

Objectives

To identify factors that predicted biologic drug persistence or discontinuation in a real‐life setting.

Methods

We identified the studies of biologic persistence in psoriasis through a comprehensive, systematic literature search using pre‐defined search criteria and screened by title/abstract then further by full‐text review. Hazard ratio (HR) data were extracted for all available predictive factors (HRs > 1 denoted biologic discontinuation, and HRs < 1 denoted biologic persistence). A meta‐analysis of hazard ratios (random‐effects model) was used to assess any predictive factor included in ≥2 studies.

Results

Sixteen cohort studies were included (n=32,194) in the review. A meta‐analysis was performed on thirteen studies (n=29,802) in total; 9 for female sex (n=28,090), 6 for obesity (n=9,311), and 6 for psoriatic arthritis (n=24,444). Obesity and female sex predicted treatment discontinuation with HRs of 1·21 (95% CI: 1·10‐1·32; I²=0%) and 1·22 (95% CI: 1·07‐1·38; I²=84%), respectively. Concomitant psoriatic arthritis predicted biologic persistence (HR: 0·83 (95% CI: 0·80‐0·86; I²=0%). Female sex predicted biologic discontinuation due to side‐effects with a pooled HR of 2·16 (95% CI: 1·39‐3·35; I²=67%). Other reported predictive factors (smoking, metabolic syndrome, biologic naivety, age, DLQI, dyslipidemia, high socioeconomic‐status, and concomitant methotrexate) were insufficient for meta‐analysis.

Conclusion

Our meta‐analysis demonstrates that female sex and obesity predicts biologic discontinuation, and concomitant psoriatic arthritis predicts biologic survival.

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