Abstract
BACKGROUND: Despite the accumulated data on the significance of clinical indicators for predicting the efficacy of interleukin inhibitor therapy, the findings are contradictory.
AIM: To determine the significance of clinical signs as predictors of the efficacy or failure of biologic therapy of moderate-to-severe psoriasis.
METHODS: The study enrolled 156 patients with psoriasis vulgaris (L40.0 according to ICD-10). The severity of the disease was assessed using standard clinical indices — PASI and BSA. The clinical efficacy was determined by the percentage of PASI reduction 50/75/90/100: good response (PASI ≥ 75) and low efficacy/poor response (PASI ≤ 50). The findings were statistically analyzed and visualized using RStudio and the R programming language. To identify factors associated with treatment efficacy, three analytical approaches were used: multivariate logistic regression, random forest algorithm, and regularized logistic regression (LASSO).
RESULTS: By Week 16, PASI scores ≥ 75 were achieved in 113 patients (72%), insufficient efficacy (PASI ≤ 50) was observed in 43 patients (27%); by Week 26 — in 129 (84%) and 24 (16%), respectively. The highest proportion of patients with insufficient responses was observed in the adalimumab and etanercept groups at Weeks 16 and 26 (46% and 57%; 27% and 25%, respectively). It has been established that the key and most consistent predictor of the efficacy of biologic therapy in patients with moderate-to-severe psoriasis is body mass index: an increase in this indicator is associated with a reduced likelihood of achieving a good clinical response. Arterial hypertension is also associated with lower treatment efficacy, while a higher HDL level can be considered an additional favorable prognostic factor.
CONCLUSION: Consideration of the metabolic and cardiovascular patient characteristics may increase the validity of the choice of biologic therapy in clinical practice.