Sociodemographic and clinical characteristics associated with multiple biologic failure in psoriasis: A 2015-2022 prospective cohort analysis of the CorEvitas psoriasis registry

Background: Psoriasis patients with poor therapeutic response to multiple biologic agents are not well characterized.Objective: To describe the characteristics associated with development of multiple biologic failure (MBF) versus good clinical response (GR) to the first biologic.Methods: This prospective cohort analysis evaluated patients in the multicenter CorEvitas Psoriasis Registry who initiated their first biologic between 2015 and 2020 and were followed for >= 24 months. Multivariable logistic regression identified sociodemographic, clinical, and patient-reported outcomes that differed between MBF (discontinued >= 2 biologics of different classes, each used for >= 90 days, due to inadequate efficacy) and GR (continued use of first biologic for >= 2 years) patients.Results: One thousand thirty-nine patients were analyzed (490 GR [47.2%], 65 MBF [6.3%]). Female sex, shorter psoriasis duration, earlier year of biologic initiation, prior nonbiologic systemic therapy use, history of hyperlipidemia, and Medicaid insurance were significantly associated with MBF, though the latter 2 variables exhibited wider confidence intervals, indicating a lower level of support. The first-to-second biologic sequence most observed with MBF was Tumor necrosis factor -a inhibitor to IL-17 inhibitor use.Limitations: Biologic adherence between visits was not evaluated.Conclusion: Approximately 6% of psoriasis patients met MBF criteria. The results identify characteristics associated with MBF that may distinguish patients warranting more frequent follow-up.