Journal de recherche clinique et expérimentale en dermatologie
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Algorithm for Selecting Ideal Biologic Treatment for Psoriasis

Yoshinori Umezawa, Akihiko Asahina, Sota Kikuchi, Koichi Yanaba and Hidemi Nakagawa

Biologics are the standard treatment for moderate-to-severe psoriasis due to their efficacy and safety. However, the selection of appropriate biologics is complicated by patient characteristics, treatment regimen, and cost. We constructed an algorithm to select biologics based on psoriasis type (psoriasis vulgaris or psoriasis arthritis), Psoriasis Area and Severity Index (PASI) score (≥ 20 or <20) and body mass index (≥ 25 or <25). To validate our algorithm, we retrospectively analyzed 134 patients treated with biologics. Based on the algorithm, patients were categorized into the following treatment groups: infliximab-appropriate (IFX-ap), n=33; adalimumab-appropriate (ADA-ap), n=44; and ustekinumab-appropriate (UST-ap), n=57. The relationship between each agent-appropriate group and the efficacy of each agent was analyzed. Among IFX-ap patients (n=33), the reduction in PASI with each treatment was as follows: inflximab (n=13), 93.2 ± 7.4%; adalimumab (n=10), 61.3 ± 29.2%; and ustekinumab (n=10), 87.4 ± 12.8%, with significant differences between infliximab and adalimumab. Among ADA-ap patients (n=44), the reduction in PASI with each treatment was as follows: infliximab (n=10), 83.3 ± 23.3%; adalimumab (n=12), 84.9 ± 23.6%; and ustekinumab (n=14), 73.0 ± 29.8%, with no significant differences between treatments. Among UST-ap patients, the reduction in PASI with each treatment was as follows: infliximab (n=15), 94.9 ± 6.0%; adalimumab (n=14), 73.0 ± 23.0%; and ustekinumab (n=28), 87.2 ± 18.0%, with a significant difference between treatment with adalimumab and ustekinumab. These results suggest that appropriate biologics selection results in increased efficacy of treatment.