Flavia Manzo Margiotta

Background Monoclonal antibodies (mAbs) directed against tumour necrosis factor alpha (TNF‐α) and interleukin (IL)‐17 and ‐23 represent the ultimate therapeutic strategy in treating psoriasis patients, but scientific literature still does not provide conclusive results regarding the possible influence of previous biological therapies on real‐life therapeutic response. Objectives The objective of our work was to investigate any putative difference in the achievement and maintenance of PASI 75, 90 and 100, as well as the probability to achieve absolute PASI ≤ 1 and ≤3, between 305 bio‐naïve and bio‐experienced patients treated with anti‐IL mAbs. Methods A comparison between previous biologic and clinical factors, including relative and absolute PASI, was carried out through chi square test. Survival curves for the achievement of PASI 75, 90 and 100 and their differences were evaluated, performing a multivariate analysis (confidence interval 95%; p < 0.0.5). Results Previous biologic therapy resulted associated with a lower rate of PASI 75 (hazard ratio [HR]: 1339; p = 0.034), 90 (HR: 1365; p = 0.0031) and 100 achievement (HR 1596; p = 0,007). The survival curves showed how bio‐experienced patients were less likely to reach and maintain PASI 90 (naïve vs. anti‐IL: p = 0.001; naïve vs. anti‐TNF + anti‐IL: p < 0.001) and PASI 100 (naïve vs. anti‐TNF‐α: p = 0.014; naïve vs. anti‐IL: p < 0.001; naïve vs. anti‐TNF‐α + anti‐IL: p < 0.001). Moreover, bio‐naïve patients showed a greater probability to achieve both absolute PASI ≤ 3 and ≤1 ( p < 0.001). Conclusions Our results represent a real‐life analysis on the impact of previous biologic therapy in the clinical efficacy of anti‐IL. Even if further studies with bigger samples are needed to extrapolate absolute considerations, we provided the first evidence on the burden of the bio‐naïve condition for a greater achievement of both PASI 90, 100 and the probability to achieve PASI ≤ 1 and ≤3.