Body Mass Index Influence for the Personalization of the Monoclonal Antibodies Therapy for Psoriasis

Abstract

Psoriasis is a chronic inflammatory, autoimmune-mediated disease that affects millions of individuals worldwide. Advances in treatment with biological agents represented by monoclonal antibodies, such as TNF-α inhibitors (TNFI), IL-17A and IL-12/23 antagonists have not only benefited from outstanding clinical efficacy with lower side effects compared to conventional systemic therapy, but also raised the standards towards therapeutic success, fact reflected in the greater Psoriasis Area and Severity Index (PASI) response rates. However, due to their relatively recent introduction in clinical practice, and despite their proven superior efficacy, further research is needed for monitoring the eventual changes in treatment-induced parameters, especially of metabolic origin. In this respect, initial reports stress on one particular comorbidity associated with psoriasis-obesity-which seems to be not only a risk and result of the disease, but also an adverse effect of long-term therapy with some biologics. The consequent drug-induced increase in body mass index (BMI) of patients suffering from psoriasis undergoing biological treatment appears to contribute to the progression of the disease, promote drug discontinuation and reduce overall clinical efficacy of monoclonal antibodies. Therefore, we review herein the impact of body weight (BMI) increase on the biological treatment of psoriasis, to further investigate on its relationship with the disease and aid on the management of treatment schemes that take into account individual characteristics of patients, such as body mass, for a more efficient and personalized therapy approach.

Efficacy and safety of ixekizumab in Chinese patients with plaque psoriasis

“…Our results also demonstrated that ixekizumab showed similar efficacy in the treatment of plaque psoriasis regardless of the baseline factors, such as age, gender, disease course, and BMI. Even BMI, a feature that seems to influence response to several biological agents, [5] did not modulate the response to ixekizumab in this study. Given that our study only included six patients who were exposed to previous therapies, we did not evaluate the effects of the use of prior drugs on this biologic agent.…”

Risankizumab Therapy for Moderate-to-Severe Psoriasis—A Multi-Center, Long-Term, Real-Life Study from Poland

“…It is well known that high values of BMI have a negative effect on the efficacy of treatment with TNF-α antagonists, ustekinumab and secukinumab [ 19 ]. When it comes to the effect of BMI on Risankizumab therapy, the data from real-life studies bring contradictory results.…”

Adherence and Persistence to Biological Drugs for Psoriasis: Systematic Review with Meta-Analysis

“…Future studies are required to elucidate on comparative efficacy because few data derived from direct “head-to-head” comparisons, and short-term efficacy outcomes were mainly evaluated [ 84 , 85 , 86 , 87 ]. A role for body mass index (BMI) in the patient’s attitude toward biological treatment has been recently proposed [ 88 , 89 ]. Indeed, the efficacy of TNF-α inhibitors and UST is reduced in obese/overweight patients with psoriasis [ 90 , 91 , 92 ], with consequences for both adherence and persistence [ 93 , 94 ].…”