Predictive Factors of Early Super-Response to Biologic Agents in Psoriasis: Insights from Real-World Evidence

The concept of early super-response (ESR) in psoriasis, characterized by rapid and sustained complete skin clearance, has recently gained clinical relevance. However, evidence regarding predictors of ESR remains limited. This study aimed to identify clinical and laboratory factors associated with ESR in patients with psoriasis vulgaris treated with biologics.

In this retrospective study, 299 patients with psoriasis vulgaris receiving biologic therapy were evaluated. ESR was defined as achieving a PASI 100 response at week 4 and maintaining PASI < 1 through week 48. Demographic, clinical, and laboratory parameters were compared between ESR and non-ESR groups. Variables with p < 0.1 in univariate analyses were entered into multivariate logistic regression to identify independent predictors.

Bio-naïve status (OR = 2.16, 95% CI 1.17-3.96, p = 0.013) and higher baseline neutrophil count (OR = 1.26, 95% CI 1.04-1.53, p = 0.016) were independent positive predictors of ESR, while palmoplantar involvement (OR = 0.27, 95% CI 0.13-0.58, p = 0.001) was a strong negative predictor. Smoking (OR = 0.57, 95% CI 0.29-1.11, p = 0.099) showed a borderline negative association, and platelet-to-lymphocyte ratio (PLR) (OR = 1.005, 95% CI 0.999-1.01, p = 0.083) demonstrated a borderline positive effect. At the biologic class level, no statistically significant differences in ESR rates were observed. Moreover, biologic class was not independently associated with ESR in multivariable analyses after adjustment for clinically relevant covariates.

Bio-naïve status and elevated baseline neutrophil count predicted rapid and sustained complete clearance with biologic therapy, whereas palmoplantar involvement impaired early response. These findings emphasize the prognostic role of baseline inflammatory and phenotypic features in guiding personalized psoriasis management.