Title : Cutaneous, metabolic and inflammatory improvements for psoriasis after different biologic treatments: A real-world longitudinal prospective study
Abstract:
Background: Many tools like psoriasis area and severity index (PASI) are commonly used to evaluate treatment efficacy in clinical settings while an optimal measure of treatment response may overlook systemic response in psoriasis patients under treatment.
Aim: To assess and compare the co-benefits of Adalinumab (ADA), Ustekinuumab (USTE), Ixekizumab (IXE), Secukizumab (SECU) and Guselkizumab (GUSE) during 24 weeks follow-up of biologic treatment for psoriasis in Chinese population.
Methods: We performed a prospective, randomized cohort study, including patients receiving systemic biologic treatment for moderate to severe psoriasis.We conducted a follow-up of psoriatic patients treated with five biologics from January 2023 to June 2024 on the basis of four timepoints: at the baseline, week 4, week 12, and week 24. From the baseline through every timepoint, we took PASI, BSA, DLQI, metabolic and inflammatory screening for assessment and comparison of clinical and systemic efficacy of biologics.
Results: This study included 385 participants, respectively treated with 5 different biologics. There was a dramatic clinical improvement from the baseline to week 24 with statistically significant difference (p <0.001). Overall, 35 patients (9.09%), 145(37.14%) and 335(86.75%) achieved PASI 100 at week 4, week 12 and week 24 of the follow-up. IXE (PASI 100=12.12 % at week 4 Vs. 87.27% at week 24) and SECU (PASI 100=7.79% at week 4 Vs. 89.92% at week 24) showed superiority compared to other biologics. At week 12, high percentage with PASI 100 was observed for GUSE (38.71%) and SECU (40.28%). Low percentage of PASI 100 was continuously maintained by ADA and USTE. We observed quicker systemic improvements due to GUSE at time point 2 (p=.041, with low value of TC and non-HDL-C, p=.046) and at week 24 for TNF-α ( p=.024) in comparison to other biologics. SECU and ADA showed higher metabolic efficacy for respectively GLU ( p=.037 at week 12) and UA (p=.033 at week 24).
Conclusion: This study confirmed clinical efficacy of biologics and its contribution to achieve complete skin clearance, and further evidenced all biologics can continuously reduce systemic inflammation. We found that biologics have different preferred roles on metabolic dysfunctions such SECU on glucose and GUSE on non-HDL.
