Identification of Demographic and Clinical Features Associated with Multi-Biologic Failure in the CorEvitas Psoriasis Registry

Clinical providers often face difficult-to-treat psoriasis patients who have failed multiple biologic agents and classes. Our objective was to identify patients with multiple biologic failure (MBF) and risk factors for MBF in the CorEvitas Psoriasis Registry. We included plaque psoriasis patients who initiated their first biologic therapy during registry enrollment and had ≥2 years of follow-up (2015-2022). We defined MBF as medically failing ≥2 biologic classes (TNFi, IL12/23i, IL17i, IL23i) with ≥90 days of treatment, and good response (GR) as ≥24 months of continued use of first biologic. Socio-demographics, lifestyle characteristics including comorbidities, psoriasis disease and treatment characteristics, and patient reported outcomes were assessed at first biologic initiation. To identify independent risk factors for MBF vs GR, a multivariable logistic regression model was constructed. The final model included a priori selected variables (age, sex, race, ethnicity, BMI) and others retaining statistical significance of P<0.10. Among the 1,039 biologic-naïve initiators, 65 (6%) were MBF and 490 (47%) were GR, mean age was 49 years, 44% were women and 78% were white. Variables independently associated with MBF included female sex (OR=2.29; 95% CI: 1.11, 4.72), hyperlipidemia (OR=3.14; 95% CI 1.35, 7.30), Medicaid insurance (OR=4.53; 95% CI 1.40, 14.60), and prior non-biologics use (OR=2.47; 95% CI: 1.16, 5.25). Year of first biologic and shorter psoriasis duration were independently associated with MBF, likely reflecting secular trends in biologics availability. These findings identify a subset of psoriasis patients who are more likely to experience MBF and who may warrant more intensive follow-up with their providers.