Factors Associated With PASI90 Maintenance Without Flare-Up and Predictors of Biologics Discontinuation in Psoriasis:...

Biologics targeting key cytokines have enabled near-complete clearance in psoriasis treatment. As 90% reduction in the Psoriasis Area and Severity Index (PASI90) emerges as a meaningful goal of treatment, maintaining PASI90 without flare-up has become important.

To identify factors associated with PASI90 maintenance for ≥1 year without flare-up and predictors of drug discontinuation.

This multicenter retrospective cohort study included moderate-to-severe plaque psoriasis patients treated with adalimumab, ustekinumab, secukinumab, ixekizumab, guselkumab, or risankizumab (2010-2022). Treatment courses were defined as "Episodes." Patients with ≥2 years of therapy were analyzed. Relative risks (RR) for PASI90 maintenance were estimated using generalized linear mixed models, and Cox proportional hazards models assessed drug discontinuation.

Among 136 patients (189 episodes), 40.1% of 162 eligible episodes achieved PASI90 maintenance without flare-up for ≥1 year. Secukinumab significantly increased the likelihood of PASI90 maintenance (RR, 2.1; 95% confidence interval [CI], 1.27-3.49). Body mass index (BMI) <30 and first biologic episode showed favorable with only trend toward significance. Psoriasis Area and Severity Index response at week 16 and first assessment strongly predicted maintenance (area under the curve, 0.80-0.82). Regarding drug discontinuation, drug were discontinued in 28.6% of episodes; BMI ≥30, family history of psoriasis, and adalimumab (hazard ratio, 4.50; 95% CI, 1.57-12.90 vs. ustekinumab) were associated with higher risk of drug discontinuation.

Secukinumab, lower BMI, and biologic-naïve status favored durable PASI90 without flare-up. Obesity, family history, and adalimumab predicted drug discontinuation. Early treatment response strongly predicted long-term efficacy.