Efficacy differences of biologic agents targeting different pathways in obese patients with psoriasis: a systematic...

To evaluate the effect of obesity on biologic efficacy in psoriasis across different drug classes.

PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to March 2026. Studies reporting obesity‑stratified outcomes of biologics for psoriasis were included. Primary outcome was PASI90 (Psoriasis Area and Severity Index); secondary outcomes were PASI75 and PASI100. Random‑effects model was used to calculate pooled relative risks (RRs). Subgroup analyses and meta‑regression explored heterogeneity.

Twelve studies (4200 patients) were included. Obese patients had lower PASI90 response (RR = 0.64; 95% confidence interval (CI): 0.55-0.76; I² = 72%), but publication bias was present (Egger p < 0.001); after trim‑and‑fill correction, RR = 0.79 (95% CI: 0.58-1.08). This finding should therefore be interpreted with caution. Significant negative effects were seen for interleukin (IL)‑17 inhibitors (RR = 0.57) and IL‑12/23 inhibitors (RR = 0.43) in subgroup analyses, but not for tumor necrosis factor‑alpha (TNF‑α) or IL‑23 inhibitors, although the small number of studies for some classes limits the robustness of these estimates. PASI75 (RR = 0.52) and PASI100 (RR = 0.42) were also lower in obese patients. Biologic class, study design, region, mean body mass index (BMI), and obesity proportion were major sources of heterogeneity.

Obesity may be associated with reduced response to biologics in psoriasis, although the PASI90 result was affected by publication bias and became non‑significant after correction. The impact appeared to differ by class, with significant effects for IL‑17 and IL‑12/23 inhibitors in subgroup analyses, but these findings require confirmation in larger studies. Weight status should be considered as one of multiple factors when selecting biologics, but current evidence does not support treatment selection based solely on obesity.